Healthcare Provider Details

I. General information

NPI: 1023332368
Provider Name (Legal Business Name): CLEVELAND ROY JOHNSON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18651 SW 128TH CT
MIAMI FL
33177-3035
US

IV. Provider business mailing address

18651 SW 128TH CT
MIAMI FL
33177-3035
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-8981
  • Fax: 305-234-3336
Mailing address:
  • Phone: 305-255-8981
  • Fax: 305-234-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRRT 8239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: