Healthcare Provider Details

I. General information

NPI: 1861561011
Provider Name (Legal Business Name): JOSE L ROBLEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15835 S 46TH ST SUITE 132
PHOENIX AZ
85048-0446
US

IV. Provider business mailing address

15835 S 46TH ST SUITE 132
PHOENIX AZ
85048-0446
US

V. Phone/Fax

Practice location:
  • Phone: 480-598-9733
  • Fax: 480-598-8891
Mailing address:
  • Phone: 480-598-9733
  • Fax: 480-598-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number13386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: