1932155157 NPI number — ENRIQUE ROBLES M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932155157 NPI number — ENRIQUE ROBLES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBLES
Provider First Name:
ENRIQUE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHENG-ROBLES
Provider Other First Name:
ENRIQUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932155157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARTESIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90702-0275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-477-3264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90240-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-927-0033
Provider Business Practice Location Address Fax Number:
562-231-1905
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A63569 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A63569 . This is a "BLUE SHIELD ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A635690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065986 . This is a "HEALTH NET ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080116639 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".




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