Healthcare Provider Details

I. General information

NPI: 1083054092
Provider Name (Legal Business Name): MARIA GUADALUPE ROBLES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8933 ACTIVITY RD
SAN DIEGO CA
92126-4427
US

IV. Provider business mailing address

8933 ACTIVITY RD
SAN DIEGO CA
92126-4427
US

V. Phone/Fax

Practice location:
  • Phone: 858-653-6121
  • Fax:
Mailing address:
  • Phone: 858-653-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN445375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: