Provider Demographics
NPI:1619738747
Name:ROBINSON, DAMITRI MESHAE (MSN, SRNA, CNL, CCRN)
Entity Type:Individual
Prefix:
First Name:DAMITRI
Middle Name:MESHAE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MSN, SRNA, CNL, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BLUEBERRY POINT ROAD
Mailing Address - Street 2:P. O. BOX 1027
Mailing Address - City:WHITE STONE
Mailing Address - State:VA
Mailing Address - Zip Code:22578
Mailing Address - Country:US
Mailing Address - Phone:804-436-7709
Mailing Address - Fax:
Practice Address - Street 1:7676 HAZARD CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4508
Practice Address - Country:US
Practice Address - Phone:800-585-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001290958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse