Basic Information
| Provider Information | |||||||||
| NPI: | 1871853861 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JORGE F. ROBLES, M.D. MEDICAL ASSOCIATE INC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | VALLEY FAMILY FAMILY PRACTICE MEDICAL ASSOCIATES INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 OCOTILLO DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EL CENTRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922434217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603536363 | ||||||||
| FaxNumber: | 7603530630 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 OCOTILLO DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EL CENTRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922434217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603536363 | ||||||||
| FaxNumber: | 7603530630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2012 | ||||||||
| LastUpdateDate: | 06/08/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBLES | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | FERNANDO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7603536363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | A52681 | CA | Y | Managed Care Organizations | Preferred Provider Organization |
ID Information
| ID | Type | State | Issuer | Description | 00A526810 | 05 | CA | MEDICAID |