Provider Demographics
NPI:1568134955
Name:ROBLEDO, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ROBLEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 VENDOLA DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2986
Mailing Address - Country:US
Mailing Address - Phone:619-208-2832
Mailing Address - Fax:
Practice Address - Street 1:7525 METROPOLITAN DR STE 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4404
Practice Address - Country:US
Practice Address - Phone:858-252-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician