Provider Demographics
NPI:1013609502
Name:COBIAN GONZALEZ, ROBERTO ANDRES
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANDRES
Last Name:COBIAN GONZALEZ
Suffix:
Gender:M
Credentials:
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 1194
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1194
Mailing Address - Country:US
Mailing Address - Phone:787-457-1692
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-1724
Practice Address - Country:US
Practice Address - Phone:787-280-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR771472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist