Provider Demographics
NPI:1679570790
Name:ROBLES RODRIGUEZ, MARIA L (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:ROBLES RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3423
Mailing Address - Street 2:BAYAMON GARDENS STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0423
Mailing Address - Country:US
Mailing Address - Phone:787-787-4036
Mailing Address - Fax:787-780-2118
Practice Address - Street 1:SAN FERNANDO
Practice Address - Street 2:E-18 AVE HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1769
Practice Address - Country:US
Practice Address - Phone:787-787-4036
Practice Address - Fax:787-780-2118
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-08-12
Deactivation Date:2007-08-20
Deactivation Code:
Reactivation Date:2009-01-29
Provider Licenses
StateLicense IDTaxonomies
PR095152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU97669Medicare UPIN