Provider Demographics
NPI:1891981577
Name:ROBLES, RAQUEL LATRICE
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:LATRICE
Last Name:ROBLES
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 1:2350 W SHAW AVE
Mailing Address - Street 2:SUITE 148
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3401
Mailing Address - Country:US
Mailing Address - Phone:559-434-3448
Mailing Address - Fax:559-431-2242
Practice Address - Street 1:2350 W SHAW AVE
Practice Address - Street 2:SUITE 148
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3401
Practice Address - Country:US
Practice Address - Phone:559-434-3448
Practice Address - Fax:559-431-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01270FMedicaid