=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376467712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NYIA KEVANNA ROBERTS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2026
-----------------------------------------------------
Last Update Date | 08/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1224 DEL MAR AVE STE A
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-3572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-626-3403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5210 TERNER WAY APT 329
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95136-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-679-7329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 230183036
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------