Provider Demographics
NPI:1104571603
Name:ROBLES, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ROBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E BASELINE RD APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1421
Mailing Address - Country:US
Mailing Address - Phone:213-984-7360
Mailing Address - Fax:
Practice Address - Street 1:1940 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2148
Practice Address - Country:US
Practice Address - Phone:909-392-1344
Practice Address - Fax:909-599-8223
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator