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NPI Code Detail

MEDICARE: LAJUAN LARRY

MEDICARE: LAJUAN LARRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1962367706
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAJUAN LARRY
Provider Business Mailing Address
First Line : 16603 HARVARD AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2203
Country : US
Telephone Number : 216-999-7444
Fax Number :
Provider Business Practice Location Address
First Line : 16603 HARVARD AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2203
Country : US
Telephone Number : 216-999-7444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2025
Last Update Date : 02/02/2026

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Directions to “ LAJUAN LARRY ” Practice Location

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