Provider Demographics
NPI:1326574773
Name:ROBLES, RYAN (FNP -BC,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ROBLES
Suffix:
Gender:M
Credentials:FNP -BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5737
Mailing Address - Country:US
Mailing Address - Phone:210-824-3130
Mailing Address - Fax:
Practice Address - Street 1:5307 BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5737
Practice Address - Country:US
Practice Address - Phone:210-824-3130
Practice Address - Fax:210-579-3130
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133922363LP0808X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily