Provider Demographics
NPI:1952122582
Name:TOMIC, MIRELA
Entity type:Individual
Prefix:
First Name:MIRELA
Middle Name:
Last Name:TOMIC
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 1:9400 RIDGESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7140
Mailing Address - Country:US
Mailing Address - Phone:216-856-1867
Mailing Address - Fax:
Practice Address - Street 1:9400 RIDGESIDE DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7140
Practice Address - Country:US
Practice Address - Phone:216-856-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty