Healthcare Provider Details

I. General information

NPI: 1003503608
Provider Name (Legal Business Name): REBECCA ALZARRAQ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

3971 SKYVIEW DR
BRUNSWICK OH
44212-1233
US

V. Phone/Fax

Practice location:
  • Phone: 440-590-5394
  • Fax:
Mailing address:
  • Phone: 440-590-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.240860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: