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NPI Code Detail

MEDICARE: LARISA MALEVANNAYA

MEDICARE: LARISA MALEVANNAYA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1861023665
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISA MALEVANNAYA
Provider Business Mailing Address
First Line : 1012 BUNKER DR APT 102
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-3066
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 29125 CHAGRIN BLVD
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-4622
Country : US
Telephone Number : 216-292-3999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2020
Last Update Date : 02/27/2020

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Directions to “ LARISA MALEVANNAYA ” Practice Location

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