Basic Information
| Provider Information | |||||||||
| NPI: | 1861561011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBLEDO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15835 S 46TH ST | ||||||||
| Address2: | SUITE 132 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805989733 | ||||||||
| FaxNumber: | 4805988891 | ||||||||
| Practice Location | |||||||||
| Address1: | 15835 S 46TH ST | ||||||||
| Address2: | SUITE 132 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805989733 | ||||||||
| FaxNumber: | 4805988891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 13386 | AZ | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | AZ0036500 | 01 | AZ | BCBS | OTHER | 219908 | 05 | AZ | MEDICAID | 86-0429186 | 01 | AZ | TRICARE | OTHER |