Provider Demographics
NPI:1053203679
Name:ROBERTSON, RIQUARDO D'MON SR
Entity type:Individual
Prefix:MR
First Name:RIQUARDO
Middle Name:D'MON
Last Name:ROBERTSON
Suffix:SR
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 1:16301 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4849
Mailing Address - Country:US
Mailing Address - Phone:216-703-4010
Mailing Address - Fax:
Practice Address - Street 1:16301 TURNEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4849
Practice Address - Country:US
Practice Address - Phone:216-703-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)