Healthcare Provider Details

I. General information

NPI: 1346166394
Provider Name (Legal Business Name): MERYLL KIM D ROBLES DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 HARMONY LN
FONTANA CA
92336-5074
US

IV. Provider business mailing address

15920 HARMONY LN
FONTANA CA
92336-5074
US

V. Phone/Fax

Practice location:
  • Phone: 323-545-8891
  • Fax:
Mailing address:
  • Phone: 323-545-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: