Healthcare Provider Details

I. General information

NPI: 1912727652
Provider Name (Legal Business Name): OHIO CITY BEAUTY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 W 25TH ST
CLEVELAND OH
44109-1617
US

IV. Provider business mailing address

3159 W 25TH ST
CLEVELAND OH
44109-1617
US

V. Phone/Fax

Practice location:
  • Phone: 216-738-9599
  • Fax:
Mailing address:
  • Phone: 216-738-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH Y CRESPO
Title or Position: MASTER PARAMEDICAL TATTOO ARTIST
Credential:
Phone: 216-457-3775