Idrissa Derra

NPI #1194309989 in Brunswick, Ohio

Provider Information

NPI Number: 1194309989
Entity Type: Individual
Name: Idrissa Derra
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: May 8, 2021
Last Updated: Nov 28, 2022

Practice Location

Address: 3906 TURNBRIDGE CT UNIT 311
City: Brunswick
State: Ohio
ZIP Code: 44212-3093
Phone: (216) 801-5639

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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