Healthcare Provider Details

I. General information

NPI: 1154828002
Provider Name (Legal Business Name): MERCEDES ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCEDES GALICIA

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 ROSCOE BLVD STE 100
VAN NUYS CA
91406-1206
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax: 619-374-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: