Healthcare Provider Details

I. General information

NPI: 1245432723
Provider Name (Legal Business Name): FLORENTINO AVILA ROBLES FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

IV. Provider business mailing address

306 CLAUDIA AUTUMN DR
BAKERSFIELD CA
93314-4766
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-8400
  • Fax: 661-758-4187
Mailing address:
  • Phone: 661-331-6248
  • Fax: 661-758-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number588050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: