=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346491776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBLES MEDICAL CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2008
-----------------------------------------------------
Last Update Date | 10/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2517 AVENUE BOULEVARD LEVITTOWN
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-261-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51090
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00950-1090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-215-3011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARLOS R ROBLES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-215-3011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 13215
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------