Provider Demographics
NPI:1043340458
Name:ROBLES, MAYRA IVELISSE
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:IVELISSE
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:H24 CALLE MIGUEL A GOMEZ
Mailing Address - Street 2:IDAMARIS GARDENS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-5718
Mailing Address - Country:US
Mailing Address - Phone:939-940-2601
Mailing Address - Fax:
Practice Address - Street 1:GJ15 AVE CAMPO RICO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2656
Practice Address - Country:US
Practice Address - Phone:787-257-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical