Healthcare Provider Details

I. General information

NPI: 1285596684
Provider Name (Legal Business Name): LADI MAFIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15805 ROCKSIDE RD
MAPLE HEIGHTS OH
44137-3954
US

IV. Provider business mailing address

15805 ROCKSIDE RD
MAPLE HEIGHTS OH
44137-3954
US

V. Phone/Fax

Practice location:
  • Phone: 216-489-5056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOROTHEA GRIGGS
Title or Position: OWNER
Credential:
Phone: 216-490-4525