Provider Demographics
NPI:1063030609
Name:ROBLES DE LA CRUZ, GABRIELINA (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELINA
Middle Name:
Last Name:ROBLES DE LA CRUZ
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 S WOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4664
Mailing Address - Country:US
Mailing Address - Phone:908-202-9135
Mailing Address - Fax:
Practice Address - Street 1:201 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3724
Practice Address - Country:US
Practice Address - Phone:212-991-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist