Provider Demographics
NPI:1659932960
Name:RIFICI, JONATHAN LOUIS (CAA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LOUIS
Last Name:RIFICI
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 CLIFTON BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2384
Mailing Address - Country:US
Mailing Address - Phone:440-865-6652
Mailing Address - Fax:
Practice Address - Street 1:5805 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3715
Practice Address - Country:US
Practice Address - Phone:216-239-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000355367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant