Healthcare Provider Details

I. General information

NPI: 1356795603
Provider Name (Legal Business Name): WALESCA ROBLES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE AZUCENA 157 CIUDAD JARDIN
CAROLINA PUERTO RICO
00987
UM

IV. Provider business mailing address

CALLE AZUCENA 157 CIUDAD JARDIN
CAROLINA PUERTO RICO
00987
UM

V. Phone/Fax

Practice location:
  • Phone: 787-462-5685
  • Fax:
Mailing address:
  • Phone: 787-462-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8791
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: