Healthcare Provider Details

I. General information

NPI: 1235463928
Provider Name (Legal Business Name): JAIME ROBLEDO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21830 KINGSLAND BLVD STE 102
KATY TX
77450-2500
US

IV. Provider business mailing address

21830 KINGSLAND BLVD STE 102
KATY TX
77450-2500
US

V. Phone/Fax

Practice location:
  • Phone: 713-590-5470
  • Fax: 713-583-2800
Mailing address:
  • Phone: 713-590-5470
  • Fax: 713-583-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK6916
License Number StateTX

VIII. Authorized Official

Name: DR. JAIME ROBLEDO
Title or Position: OWNER
Credential: M.D.
Phone: 713-590-5470