Healthcare Provider Details

I. General information

NPI: 1063982999
Provider Name (Legal Business Name): BIANCA LIZETH ROBLES AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LITTON DR STE 204
GRASS VALLEY CA
95945-5079
US

IV. Provider business mailing address

251 LLEWELLYN AVE BLDG F
CAMPBELL CA
95008-1940
US

V. Phone/Fax

Practice location:
  • Phone: 530-715-6311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: