Healthcare Provider Details

I. General information

NPI: 1609132059
Provider Name (Legal Business Name): ANGELICA VICTORIA ROBLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 SPRINGBANK LN STE C
CHARLOTTE NC
28226-3347
US

IV. Provider business mailing address

501 S SHARON AMITY RD STE 500
CHARLOTTE NC
28211-2897
US

V. Phone/Fax

Practice location:
  • Phone: 980-890-8668
  • Fax: 833-471-2100
Mailing address:
  • Phone: 980-890-8668
  • Fax: 833-471-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018-01232
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number2018-01232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: