Provider Demographics
NPI:1164087904
Name:ROBLES, MYRA IVETTE (NP)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:IVETTE
Last Name:ROBLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 GERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1836
Mailing Address - Country:US
Mailing Address - Phone:915-591-2704
Mailing Address - Fax:915-598-3946
Practice Address - Street 1:400 SHADOW MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4030
Practice Address - Country:US
Practice Address - Phone:915-591-2704
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty