Basic Information
| Provider Information | |||||||||
| NPI: | 1457413759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBLES | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9939 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513543216 | ||||||||
| FaxNumber: | 9518489968 | ||||||||
| Practice Location | |||||||||
| Address1: | 3770 S 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857136081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206201200 | ||||||||
| FaxNumber: | 5206201400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3460 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Z78444 | 01 | AZ | MEDICARE PIN GROUP | OTHER | PA15645 | 05 | CA | MEDICAID | 0PA15645 | 01 | CA | MEDICARE PPIN | OTHER | 132095 | 01 | AZ | AHCCCS | OTHER | 706393 | 01 | AZ | AHCCCS GROUP | OTHER |