MEDICARE: MISS IVONNE MONICA ROBLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1871711986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS IVONNE MONICA ROBLES

Provider Business Mailing Address
First Line	:	14015 ZIRCON ST
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92344-4608
Country	:	US
Telephone Number	:	323-369-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	14558 SYLVAN ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2324
Country	:	US
Telephone Number	:	818-787-4151
Fax Number	:	818-787-2840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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