Healthcare Provider Details

I. General information

NPI: 1134831761
Provider Name (Legal Business Name): PAOLO ANGELO GICA BALAGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

7270 EUCLID AVE APT 304
CLEVELAND OH
44103-4018
US

V. Phone/Fax

Practice location:
  • Phone: 216-407-7046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-267536
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0032837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: