Provider Demographics
NPI:1841751294
Name:GONZALEZ ROBLES, CAMILLE MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:MARIE
Last Name:GONZALEZ ROBLES
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 1:1063 CALLE GONZALEZ
Mailing Address - Street 2:URB. SANTA RITA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:939-226-5281
Mailing Address - Fax:
Practice Address - Street 1:1063 CALLE GONZALEZ
Practice Address - Street 2:URB. SANTA RITA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:939-226-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR22535208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22535OtherGENERAL PRACTICE PHYSICIAN