Provider Demographics
NPI:1417180811
Name:ROBLEDO, JESSICA LOPEZ
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOPEZ
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 1:2351 CARDINAL LN
Mailing Address - Street 2:ANNEX B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3743
Mailing Address - Country:US
Mailing Address - Phone:858-573-2227
Mailing Address - Fax:858-496-2113
Practice Address - Street 1:2351 CARDINAL LN
Practice Address - Street 2:ANNEX B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3743
Practice Address - Country:US
Practice Address - Phone:858-573-2227
Practice Address - Fax:858-496-2113
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist