Individual provider Active NPI

Victor H Robles, P.A.

  • Physician Assistant
  • Garden Grove, CA
National Provider Identifier
1457368227
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 17743 Issued in CA
Practice address
12555 Garden Grove Blvd
Suite 206
Garden Grove, CA 92843-1902
Phone
(714) 537-6595
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 17743 CA Primary

Addresses

Primary practice location

12555 Garden Grove Blvd
Suite 206
Garden Grove, CA 92843-1902

Mailing address

12555 Garden Grove Blvd
Suite 206
Garden Grove, CA 92843-1902
Phone (714) 537-6595

Other identifiers 2

IdentifierTypeStateIssuer
19775OtherCARESPIRATORY CARE PROVIDER
PA 17743OtherCACALIFORNIA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120507000191 CA Practitioner - Physician Assistant 0345402475 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 17743CAMDPhysician Assistant
17743CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Jul 1, 2015 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457368227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD",
            "address_2": "SUITE 206",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431902",
            "telephone_number": "714-537-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD",
            "address_2": "SUITE 206",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431902",
            "telephone_number": "714-537-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBLES",
        "first_name": "VICTOR",
        "middle_name": "H",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 17743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESPIRATORY CARE PROVIDER",
            "identifier": "19775",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LICENSE",
            "identifier": "PA 17743",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.