Healthcare Provider Details

I. General information

NPI: 1083757579
Provider Name (Legal Business Name): ANGELA MASTRONARDI D.C., L.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21245 LORAIN RD STE 111
FAIRVIEW PARK OH
44126-2138
US

IV. Provider business mailing address

350 LONG POINTE DR
AVON LAKE OH
44012-2424
US

V. Phone/Fax

Practice location:
  • Phone: 440-212-1901
  • Fax:
Mailing address:
  • Phone: 440-212-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: