Provider Demographics
NPI:1538716212
Name:CLEVELAND, TJ
Entity type:Individual
Prefix:
First Name:TJ
Middle Name:
Last Name:CLEVELAND
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 1:2702 N JUDGE ELY BLVD APT 622
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2121
Mailing Address - Country:US
Mailing Address - Phone:361-649-5028
Mailing Address - Fax:
Practice Address - Street 1:2702 N JUDGE ELY BLVD APT 622
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2121
Practice Address - Country:US
Practice Address - Phone:361-649-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program