Healthcare Provider Details

I. General information

NPI: 1558964395
Provider Name (Legal Business Name): SUSANA ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S BRAND BLVD
SAN FERNANDO CA
91340-4002
US

IV. Provider business mailing address

8112 AUTUMN ANGELS PL
BAKERSFIELD CA
93311-8307
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-0223
  • Fax:
Mailing address:
  • Phone: 818-447-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122041
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: