Provider Demographics
NPI:1326782806
Name:AUSTIN, INDIA DOMINIQUE
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:DOMINIQUE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38340 CROSSBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8170
Mailing Address - Country:US
Mailing Address - Phone:216-315-3935
Mailing Address - Fax:
Practice Address - Street 1:38340 CROSSBROOK AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8170
Practice Address - Country:US
Practice Address - Phone:216-315-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)