Provider Demographics
NPI:1023611266
Name:ROBLES, KEVIN DAVID
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:ROBLES
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 1:16350 VENTURA BLVD STE D-806
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5300
Mailing Address - Country:US
Mailing Address - Phone:818-788-1003
Mailing Address - Fax:
Practice Address - Street 1:16350 VENTURA BLVD STE D-806
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5300
Practice Address - Country:US
Practice Address - Phone:818-788-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2024-10-18
Deactivation Date:2024-03-12
Deactivation Code:
Reactivation Date:2024-10-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician