Provider Demographics
NPI:1982425401
Name:JOHNSON, JABRIL CORTEZ
Entity type:Individual
Prefix:
First Name:JABRIL
Middle Name:CORTEZ
Last Name:JOHNSON
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 1:26460 WESTPHAL ST APT 117
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3777
Mailing Address - Country:US
Mailing Address - Phone:313-942-2904
Mailing Address - Fax:
Practice Address - Street 1:26460 WESTPHAL ST APT 117
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3777
Practice Address - Country:US
Practice Address - Phone:313-942-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide