Provider Demographics
NPI:1083328819
Name:ROBERTO, CINDY JENNIFER
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:JENNIFER
Last Name:ROBERTO
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 1:6101 W CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6337
Mailing Address - Country:US
Mailing Address - Phone:310-748-9039
Mailing Address - Fax:
Practice Address - Street 1:22939 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5522
Practice Address - Country:US
Practice Address - Phone:310-748-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst