Provider Demographics
NPI:1992520274
Name:ROBERTSON, ARIYAH L
Entity type:Individual
Prefix:
First Name:ARIYAH
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12397 SAN JOSE BLVD APT 1227
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2816
Mailing Address - Country:US
Mailing Address - Phone:904-898-9130
Mailing Address - Fax:
Practice Address - Street 1:12397 SAN JOSE BLVD APT 1227
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2816
Practice Address - Country:US
Practice Address - Phone:904-898-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver