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General NPI Number Information
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NPI Number | 1497965198
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Entity Type | Individual
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Provider Name | RAFAEL O ROBLEDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 42388 PELICAN PROFESSIONAL PARK
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City | HAMMOND
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State | LA
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Zip | 70403-2412
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Country | US
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Telephone | 985-542-6251
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Fax | 985-345-2386
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Provider Business Mailing Address
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Address Line | PO BOX 1799
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City | HAMMOND
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State | LA
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Zip | 70404-1799
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Country | US
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Telephone | 985-542-6251
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Fax | 985-345-2386
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 203282
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License Number State | LA
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