Provider Demographics
NPI:1669589412
Name:OBLEDO, FERNANDO JORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JORGE
Last Name:OBLEDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 812
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3415
Mailing Address - Country:US
Mailing Address - Phone:210-692-3711
Mailing Address - Fax:210-692-7435
Practice Address - Street 1:7711 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 812
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3415
Practice Address - Country:US
Practice Address - Phone:210-692-3711
Practice Address - Fax:210-692-7435
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2935103T00000X
TX2-2935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QH12Medicare ID - Type Unspecified