Provider Demographics
NPI:1073123360
Name:FERNANDEZ, GREGORIO JOSE ROBLES
Entity Type:Individual
Prefix:MR
First Name:GREGORIO
Middle Name:JOSE ROBLES
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD
Mailing Address - Street 2:STE 200A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-782-9312
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:225 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3430
Practice Address - Country:US
Practice Address - Phone:832-691-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145545363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health