Provider Demographics
NPI:1437515871
Name:CLEVELAND, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CLEVELAND
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:HCO3 BOX 2047
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321
Mailing Address - Country:US
Mailing Address - Phone:520-993-9592
Mailing Address - Fax:
Practice Address - Street 1:STATE RTE 86 FEDERAL RTE 1 MILEPOST 19
Practice Address - Street 2:GUVO VILLAGE
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-993-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01511652343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)