Basic Information
| Provider Information | |||||||||
| NPI: | 1013394733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIOTT | ||||||||
| FirstName: | VALENCIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 MIDDLEHURST RD APT 202 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441181651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738201915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25550 CHAGRIN BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167650500 | ||||||||
| FaxNumber: | 2167650521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2015 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.