Provider Demographics
NPI:1134676760
Name:ROBINSON, REUBEN SELASSIEI
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:SELASSIEI
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 NELSON PL SE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7717
Mailing Address - Country:US
Mailing Address - Phone:202-560-7771
Mailing Address - Fax:
Practice Address - Street 1:2929 NELSON PLACE SE APT# 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7717
Practice Address - Country:US
Practice Address - Phone:202-560-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00606918374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide