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General NPI Number Information
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NPI Number | 1689251167
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Entity Type | Individual
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Provider Name | NICOLE JILA GHAFFARI DO
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Gender | Female
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 16761 SOUTHPARK CTR
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City | STRONGSVILLE
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State | OH
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Zip | 44136-9302
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Country | US
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Telephone | 440-878-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 CEDARWOOD DR APT B
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City | WESTLAKE
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State | OH
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Zip | 44145-2178
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Country | US
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Telephone | 440-714-0522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34.017344
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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