Healthcare Provider Details

I. General information

NPI: 1366517716
Provider Name (Legal Business Name): JORGE FERNANDO ROBLES SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 OCOTILLO DR STE C
EL CENTRO CA
92243-4217
US

IV. Provider business mailing address

516 WEST ATEN ROAD SUITE 2
IMPERIAL CA
92251
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6363
  • Fax: 760-355-9521
Mailing address:
  • Phone: 760-355-7730
  • Fax: 760-355-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: