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General NPI Number Information
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NPI Number | 1073123360
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Entity Type | Individual
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Provider Name | MR. GREGORIO JOSE ROBLES FERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 225 N VIRGINIA ST
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City | PORT LAVACA
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State | TX
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Zip | 77979-3430
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Country | US
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Telephone | 832-691-4694
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 N LAMAR BLVD STE 200A
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City | AUSTIN
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State | TX
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Zip | 78753-5976
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Country | US
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Telephone | 512-782-9312
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Fax | 512-782-9316
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP145545
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License Number State | TX
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