MEDICARE: MRS. CAMILLE MARIE GONZALEZ ROBLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	22535	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22535	OTHER	PR	GENERAL PRACTICE PHYSICIAN

General Provider Information

NPI Number	:	1841751294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLE MARIE GONZALEZ ROBLES M.D.

Provider Business Mailing Address
First Line	:	1063 CALLE GONZALEZ
Second Line	:	URB. SANTA RITA
City	:	SAN JUAN
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	939-226-5281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1063 CALLE GONZALEZ
Second Line	:	URB. SANTA RITA
City	:	SAN JUAN
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	939-226-5281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	05/28/2022

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Directions to “ MRS. CAMILLE MARIE GONZALEZ ROBLES M.D.” Practice Location

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