Healthcare Provider Details

I. General information

NPI: 1568073864
Provider Name (Legal Business Name): GUADALUPE TONANTZIN ROBLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 INDUSTRY WAY
LYNWOOD CA
90262-4024
US

IV. Provider business mailing address

2892 N BELLFLOWER BLVD UNIT 2218
LONG BEACH CA
90815-1125
US

V. Phone/Fax

Practice location:
  • Phone: 310-667-4070
  • Fax:
Mailing address:
  • Phone: 562-619-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW123899
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: