Healthcare Provider Details

I. General information

NPI: 1144483090
Provider Name (Legal Business Name): BERTHA IZAURA ROBLES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 WEST 52ND AVE
ARVADA CO
80002
US

IV. Provider business mailing address

3760 VANCE ST STE 201
WHEAT RIDGE CO
80033-6298
US

V. Phone/Fax

Practice location:
  • Phone: 303-463-5941
  • Fax:
Mailing address:
  • Phone: 731-352-7907
  • Fax: 731-352-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004252
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: