Healthcare Provider Details

I. General information

NPI: 1093160954
Provider Name (Legal Business Name): AMALIA ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801MIRANDA AVE., DEPT. OF VETERANS AFFAIRS ,
PALO ALTO CA
94304
US

IV. Provider business mailing address

3750 TAMAYO ST APT 152
FREMONT CA
94536-3370
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA 61732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: