Healthcare Provider Details

I. General information

NPI: 1104456268
Provider Name (Legal Business Name): JANE MAINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 E 232ND ST
EUCLID OH
44117-2018
US

IV. Provider business mailing address

1765 E 232ND ST
EUCLID OH
44117-2018
US

V. Phone/Fax

Practice location:
  • Phone: 216-688-7173
  • Fax: 216-938-7436
Mailing address:
  • Phone: 216-688-7173
  • Fax: 216-938-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSQ609632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: