Healthcare Provider Details

I. General information

NPI: 1295123321
Provider Name (Legal Business Name): APOLLO ROBLES JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 S GRAMERCY PL APT 304
LOS ANGELES CA
90020-4548
US

IV. Provider business mailing address

358 S GRAMERCY PL APT 304
LOS ANGELES CA
90020-4548
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-8785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294159
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: