Provider Demographics
NPI:1154806875
Name:ROBINSON, VICENTE DEJON (LMP)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:DEJON
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 SUNSET BLVD N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5514
Mailing Address - Country:US
Mailing Address - Phone:425-226-6622
Mailing Address - Fax:
Practice Address - Street 1:352 SUNSET BLVD N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5514
Practice Address - Country:US
Practice Address - Phone:425-226-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60319065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist