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General NPI Number Information
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NPI Number | 1568265833
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Entity Type | Individual
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Provider Name | KELVIN ROBLES DE JESUS ST
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Gender | Male
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1995 E OAKLAND PARK BLVD STE 310
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City | FT LAUDERDALE
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State | FL
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Zip | 33306-1138
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Country | US
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Telephone | 954-791-6146
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 936535
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City | ATLANTA
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State | GA
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Zip | 31193-6535
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Country | US
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Telephone |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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