Healthcare Provider Details

I. General information

NPI: 1053839324
Provider Name (Legal Business Name): MS. JAZLIEN RAYNETTE ROBLERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 SOUTH ST STE 208B
CERRITOS CA
90703
US

IV. Provider business mailing address

9303 DANBY AVE
SANTA FE SPRINGS CA
90670-2342
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-5526
  • Fax: 562-924-1040
Mailing address:
  • Phone: 562-322-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: