Provider Demographics
NPI:1467290007
Name:CLEVELAND-HAYWARD, IDEALIA
Entity type:Individual
Prefix:
First Name:IDEALIA
Middle Name:
Last Name:CLEVELAND-HAYWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IDEALIA
Other - Middle Name:
Other - Last Name:CLEVELAND-NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3409 N 7TH AVE # 11
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3635
Mailing Address - Country:US
Mailing Address - Phone:602-855-6711
Mailing Address - Fax:
Practice Address - Street 1:222 E JEFFERSON ST APT 2101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-0421
Practice Address - Country:US
Practice Address - Phone:602-855-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD03804708343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)