Provider Demographics
NPI:1861836363
Name:MOSBY, RUBEN DARSHAWN
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:DARSHAWN
Last Name:MOSBY
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 1:16215 HUNTMERE AVE
Mailing Address - Street 2:DOWN
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1546
Mailing Address - Country:US
Mailing Address - Phone:216-253-4681
Mailing Address - Fax:
Practice Address - Street 1:16215 HUNTMERE AVE
Practice Address - Street 2:DOWN
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1546
Practice Address - Country:US
Practice Address - Phone:216-253-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400122150502376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide