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General NPI Number Information
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NPI Number | 1053533117
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Entity Type | Individual
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Provider Name | ROMAN ROBLES L.AC., P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 10 E MARTIN LUTHER KING JR.
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City | STOCKTON
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State | CA
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Zip | 95206
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Country | US
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Telephone | 208-819-9759
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E MARTIN LUTHER KING JR BLVD
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City | STOCKTON
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State | CA
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Zip | 95206-1357
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Country | US
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Telephone | 209-819-9759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 10537
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12500
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License Number State | CA
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