Basic Information
| Provider Information | |||||||||
| NPI: | 1932155157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHENG - ROBLES | ||||||||
| FirstName: | ENRIQUE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 275 | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907020275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622824026 | ||||||||
| FaxNumber: | 5626222971 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 TELEGRAPH RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902402393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629270033 | ||||||||
| FaxNumber: | 5622311905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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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 | 207Q00000X | A63569 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 065986 | 01 | HEALTH NET ID # | OTHER | 00A63569 | 01 | BLUE SHIELD ID # | OTHER | 080116639 | 01 | RAILROAD | OTHER | 00A635690 | 05 | CA | MEDICAID |