Healthcare Provider Details

I. General information

NPI: 1821330937
Provider Name (Legal Business Name): JESSICA R GARUCCIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AUBURN DR # 210
BEACHWOOD OH
44122-4317
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-5595
  • Fax: 216-844-5522
Mailing address:
  • Phone: 216-844-5595
  • Fax: 216-844-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: