Provider Demographics
NPI:1932617156
Name:ROBLEDO, CONNIE A (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:ROBLEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:#100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:888-562-5442
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:200 OCEANGATE
Practice Address - Street 2:#100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4317
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020005363LF0000X
CA95008362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily