Provider Demographics
NPI:1538677406
Name:ROBLES ROSA, NEREIDA
Entity Type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:ROBLES ROSA
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:PO BOX 30783
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-1783
Mailing Address - Country:US
Mailing Address - Phone:787-633-1636
Mailing Address - Fax:
Practice Address - Street 1:COOPERATIVA DE VIVIENDA CIUDAD UNIVERSITARIA
Practice Address - Street 2:EDIFICIO A OFICINA G0006
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-633-1636
Practice Address - Fax:787-280-0099
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist