Healthcare Provider Details

I. General information

NPI: 1396825899
Provider Name (Legal Business Name): DOMENICA ZUCCARO A.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOMENICA RANDAU

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 ROCKSIDE RD SUITE 200
INDEPENDENCE OH
44131-2358
US

IV. Provider business mailing address

6701 ROCKSIDE RD SUITE 200
INDEPENDENCE OH
44131-2358
US

V. Phone/Fax

Practice location:
  • Phone: 216-674-5230
  • Fax: 216-674-5231
Mailing address:
  • Phone: 216-674-5230
  • Fax: 216-674-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: