Provider Demographics
NPI:1083419824
Name:WATSON, RUBY DEBINESE
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:DEBINESE
Last Name:WATSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E 159TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2415
Mailing Address - Country:US
Mailing Address - Phone:216-235-7268
Mailing Address - Fax:
Practice Address - Street 1:16000 TERRACE RD APT 612
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2069
Practice Address - Country:US
Practice Address - Phone:216-268-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant