Provider Demographics
NPI:1356047476
Name:ROBINSON, GABRIEL ENZY
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ENZY
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 1:1302 SUNNYRIDGE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3893
Mailing Address - Country:US
Mailing Address - Phone:262-744-5789
Mailing Address - Fax:
Practice Address - Street 1:1302 SUNNYRIDGE RD APT 2
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3893
Practice Address - Country:US
Practice Address - Phone:262-744-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI035621801698174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals