Provider Demographics
NPI:1457413759
Name:ROBLES, MARIA G (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:ROBLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3528
Mailing Address - Country:US
Mailing Address - Phone:951-354-3216
Mailing Address - Fax:951-848-9968
Practice Address - Street 1:3770 S 16TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6081
Practice Address - Country:US
Practice Address - Phone:520-620-1200
Practice Address - Fax:520-620-1400
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78444OtherMEDICARE PIN GROUP
CAPA15645Medicaid
CA0PA15645OtherMEDICARE PPIN
AZ132095OtherAHCCCS
AZ706393OtherAHCCCS GROUP
CAPA15645Medicaid
AZ706393OtherAHCCCS GROUP