Provider Demographics
NPI:1053970343
Name:RYAN ROBLES FNP-BC PMHNP-BC PLLC
Entity type:Organization
Organization Name:RYAN ROBLES FNP-BC PMHNP-BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC PMHNP-BC
Authorized Official - Phone:210-481-8673
Mailing Address - Street 1:4242 WOODCOCK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1325
Mailing Address - Country:US
Mailing Address - Phone:210-481-8673
Mailing Address - Fax:
Practice Address - Street 1:4242 WOODCOCK DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1325
Practice Address - Country:US
Practice Address - Phone:210-481-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty