Healthcare Provider Details

I. General information

NPI: 1861908808
Provider Name (Legal Business Name): YASHUA GONZALEZ ROBLEDO MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 07/26/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4053 18TH ST
SAN FRANCISCO CA
94114-2535
US

IV. Provider business mailing address

PO BOX 14823
SAN FRANCISCO CA
94114-0823
US

V. Phone/Fax

Practice location:
  • Phone: 415-484-6509
  • Fax:
Mailing address:
  • Phone: 415-484-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number103292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: