Healthcare Provider Details

I. General information

NPI: 1063307171
Provider Name (Legal Business Name): CHRISTINA ROBLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

IV. Provider business mailing address

470 MOSELEY ST
ELGIN IL
60123-7542
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax: 847-695-0484
Mailing address:
  • Phone: 847-754-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: