Healthcare Provider Details

I. General information

NPI: 1497940175
Provider Name (Legal Business Name): ROBERTO REBLE BAMBA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 HOLLY AVE NE
ALBUQUERQUE NM
87113-2472
US

IV. Provider business mailing address

311 N SUNNY COVE PL
TUCSON AZ
85748-0038
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2505
  • Fax: 505-298-2985
Mailing address:
  • Phone: 505-486-0176
  • Fax: 520-523-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2010-0169
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: