Provider Demographics
NPI:1215381298
Name:ROBLEDO, DIANA VALERIE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:VALERIE
Last Name:ROBLEDO
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 1:281 W 24TH ST STE 147
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8587
Mailing Address - Country:US
Mailing Address - Phone:928-259-9362
Mailing Address - Fax:
Practice Address - Street 1:281 W 24TH STREET
Practice Address - Street 2:SUITE 147
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-9257
Practice Address - Country:US
Practice Address - Phone:928-259-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist