Healthcare Provider Details

I. General information

NPI: 1952816530
Provider Name (Legal Business Name): MRS. JOLEAN NICOLE GONZALES ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9392
  • Fax: 562-981-2622
Mailing address:
  • Phone: 562-981-9392
  • Fax: 562-981-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: