Provider Demographics
NPI:1932155157
Name:CHENG - ROBLES, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CHENG - ROBLES
Suffix:
Gender:M
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0275
Mailing Address - Country:US
Mailing Address - Phone:562-282-4026
Mailing Address - Fax:562-622-2971
Practice Address - Street 1:9040 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2393
Practice Address - Country:US
Practice Address - Phone:562-927-0033
Practice Address - Fax:562-231-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
065986OtherHEALTH NET ID #
00A63569OtherBLUE SHIELD ID #
080116639OtherRAILROAD
CA00A635690Medicaid
CA00A635690Medicaid
G28236Medicare UPIN
CAWA63569AMedicare PIN
CAWA63569BMedicare PIN