Basic Information
| Provider Information | |||||||||
| NPI: | 1871502211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JABLONSKY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 E DIVISADERO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575500 | ||||||||
| FaxNumber: | 5594575599 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 E DIVISADERO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575500 | ||||||||
| FaxNumber: | 5594575599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A46510 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 46510 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 00A465100 | 05 | CA | MEDICAID | RHM53898F | 05 | CA | MEDICAID | 00A465102 | 05 | CA | MEDICAID |