Provider Demographics
NPI:1790888774
Name:ROBLERO, URSULA RENEE (MD)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:RENEE
Last Name:ROBLERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MEDICINE HORSE DR
Mailing Address - Street 2:
Mailing Address - City:TO'HAJIILEE
Mailing Address - State:NM
Mailing Address - Zip Code:87026
Mailing Address - Country:US
Mailing Address - Phone:505-908-2307
Mailing Address - Fax:
Practice Address - Street 1:129 MEDICINE HORSE DR.
Practice Address - Street 2:
Practice Address - City:TO'HAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:505-908-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78837207Q00000X
NMMD2006-0305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
NMH3451Medicaid
H94462Medicare UPIN