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General NPI Number Information
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NPI Number | 1164669065
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Entity Type | Organization
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Legal Business Name | MANAL H ASSAAD
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 4360 FULTON DR NW SUITE A
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City | CANTON
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State | OH
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Zip | 44718-2878
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Country | US
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Telephone | 330-433-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 4360 FULTON DR NW SUITE A
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City | CANTON
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State | OH
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Zip | 44718-2878
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BONNIE TRUETT
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Credential |
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Telephone | 330-433-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35074361
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License Number State | OH
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