Provider Demographics
NPI:1649901455
Name:RANALLO, VICTORIA C (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:RANALLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5330
Mailing Address - Country:US
Mailing Address - Phone:440-547-8204
Mailing Address - Fax:
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-312-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.007964RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant