Provider Demographics
NPI:1326079419
Name:ROBLES, JESUS ANTONIO (PA-C)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ANTONIO
Last Name:ROBLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:SANTAMARIA
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8771 W STATE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10015 W ROYAL OAK RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3164
Practice Address - Country:US
Practice Address - Phone:623-815-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3320207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine