Provider Demographics
NPI:1104361930
Name:ROBLEDO, CRISTOBAL (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:ROBLEDO
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W 102ND ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3553
Mailing Address - Country:US
Mailing Address - Phone:708-577-9077
Mailing Address - Fax:
Practice Address - Street 1:2900 W 102ND ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3553
Practice Address - Country:US
Practice Address - Phone:708-577-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000484246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant