Provider Demographics
NPI:1245784438
Name:ROBLES, ROBERT (LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:ROBLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SIMPKINS DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2688
Mailing Address - Country:US
Mailing Address - Phone:860-209-4377
Mailing Address - Fax:
Practice Address - Street 1:37 WATERBURY RD STE 2N
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1239
Practice Address - Country:US
Practice Address - Phone:860-209-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist