Provider Demographics
NPI:1114737129
Name:LOVE, AISHA IRRION
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:IRRION
Last Name:LOVE
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 1:24390 LAKE SHORE BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1277
Mailing Address - Country:US
Mailing Address - Phone:216-326-8001
Mailing Address - Fax:
Practice Address - Street 1:24390 LAKE SHORE BLVD APT C
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1277
Practice Address - Country:US
Practice Address - Phone:216-326-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
OHRN445432172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver