Healthcare Provider Details

I. General information

NPI: 1285396960
Provider Name (Legal Business Name): MISS JESSICA MARIE ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 WOODSIDE RD
REDWOOD CITY CA
94061-3847
US

IV. Provider business mailing address

2059 CAMDEN AVE # 348
SAN JOSE CA
95124-2024
US

V. Phone/Fax

Practice location:
  • Phone: 650-364-7988
  • Fax:
Mailing address:
  • Phone: 408-386-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: