Provider Demographics
NPI:1013587153
Name:ROBLES, JAYDEE JACOB (DACM)
Entity Type:Individual
Prefix:DR
First Name:JAYDEE
Middle Name:JACOB
Last Name:ROBLES
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 SOUTHGATE CIR # 8
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5514
Mailing Address - Country:US
Mailing Address - Phone:941-363-1056
Mailing Address - Fax:941-870-6651
Practice Address - Street 1:3205 SOUTHGATE CIR # 8
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:941-363-1056
Practice Address - Fax:941-870-6651
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13278692-1201171100000X
FLTPAP9171100000X
MDU02824171100000X
FLRPT103211183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT103211OtherFLORIDA BOARD OF PHARMACY
FLTPAP9OtherFLORIDA BOARD OF ACUPUNCTURE REGISTRATION
MDU02824OtherMARYLAND BOARD OF ACUPUNCTURE LICENSE