Provider Demographics
NPI:1720611080
Name:ROBINSON, JAJUAN LAMAR
Entity Type:Individual
Prefix:
First Name:JAJUAN
Middle Name:LAMAR
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 1:5265 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2407
Mailing Address - Country:US
Mailing Address - Phone:216-297-5444
Mailing Address - Fax:
Practice Address - Street 1:5265 E 104TH ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2407
Practice Address - Country:US
Practice Address - Phone:216-297-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator