Healthcare Provider Details

I. General information

NPI: 1508069261
Provider Name (Legal Business Name): DR. MIGUEL ROBLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 51991
TOA BAJA PR
00950-1991
US

IV. Provider business mailing address

771 AVE ANDALUCIA PUERTO NUEVO
SAN JUAN PR
00921-1803
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-1983
  • Fax: 787-706-8823
Mailing address:
  • Phone: 787-707-1983
  • Fax: 787-706-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: