Healthcare Provider Details

I. General information

NPI: 1619535960
Provider Name (Legal Business Name): JESSICA AIDA ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA AIDA MONROY

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 E LAKESHORE DR
LAKE ELSINORE CA
92530-4411
US

IV. Provider business mailing address

2499 E LAKESHORE DR
LAKE ELSINORE CA
92530-4411
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4200
  • Fax: 951-486-5075
Mailing address:
  • Phone: 951-471-4200
  • Fax: 951-486-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: