Provider Demographics
NPI:1447599345
Name:ROBLES, MARICELA GOMEZ (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARICELA
Middle Name:GOMEZ
Last Name:ROBLES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 N WILLOW WOODS DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1403
Mailing Address - Country:US
Mailing Address - Phone:714-777-3626
Mailing Address - Fax:
Practice Address - Street 1:1785 N WILLOW WOODS DR
Practice Address - Street 2:UNIT C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1403
Practice Address - Country:US
Practice Address - Phone:714-777-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist