Healthcare Provider Details

I. General information

NPI: 1659138048
Provider Name (Legal Business Name): REGINA S ROBLES MSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA S LOWENBERG SLPA

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 VIA VERDE STE 200
SAN DIMAS CA
91773-3993
US

IV. Provider business mailing address

1604 E RETFORD ST
COVINA CA
91724-2815
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone: 323-334-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: