Provider Demographics
NPI:1689431728
Name:DEMITRO, GINO EMMANUEL
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:EMMANUEL
Last Name:DEMITRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4909
Mailing Address - Country:US
Mailing Address - Phone:216-460-9319
Mailing Address - Fax:
Practice Address - Street 1:6614 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4909
Practice Address - Country:US
Practice Address - Phone:216-460-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty