Healthcare Provider Details

I. General information

NPI: 1205790250
Provider Name (Legal Business Name): ANDRES TANO ROBLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6034 SNORKEL SQ
CONVERSE TX
78109-4415
US

IV. Provider business mailing address

6034 SNORKEL SQ
CONVERSE TX
78109-4415
US

V. Phone/Fax

Practice location:
  • Phone: 737-781-1758
  • Fax:
Mailing address:
  • Phone: 737-781-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358436
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: