Individual
JAKARTA WASHINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13507 BEAUMONT AVE, EAST CLEVELAND, OH 44112-2420
(216) 554-9572
Mailing address
13507 BEAUMONT AVE, EAST CLEVELAND, OH 44112-2420
(216) 554-9572
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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