Basic Information
| Provider Information | |||||||||
| NPI: | 1790888774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBLERO | ||||||||
| FirstName: | URSULA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 MEDICINE HORSE DR | ||||||||
| Address2: | |||||||||
| City: | TO'HAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 129 MEDICINE HORSE DR. | ||||||||
| Address2: | |||||||||
| City: | TO'HAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | 5059082306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A78837 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2006-0305 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | H3451 | 05 | NM | MEDICAID |