Provider Demographics
NPI:1912539347
Name:ROBBINS, RODERICK II
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:ROBBINS
Suffix:II
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 1:1205 CHECKMARK AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0749
Mailing Address - Country:US
Mailing Address - Phone:725-200-8631
Mailing Address - Fax:
Practice Address - Street 1:3940 N. MARTIN LUTHER KING BLVD B106
Practice Address - Street 2:
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-476-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant