Provider Demographics
NPI:1245537323
Name:ROBLEDO, JOSE R (CRNA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:ROBLEDO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 RAYNOLDS ST # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1613
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:2000 TRANSMOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:915-215-5666
Practice Address - Fax:915-215-5047
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677665367500000X
TXAP119965367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8644UMOtherBCBS
TX220784706Medicaid
TXP01712826OtherRR
TX220784707Medicaid
TX327356YK6UMedicare PIN