Provider Demographics
NPI:1184386419
Name:ROBLES, MA. REGINA BLANCA C (LAC, DAOM)
Entity type:Individual
Prefix:DR
First Name:MA. REGINA BLANCA
Middle Name:C
Last Name:ROBLES
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:DR
Other - First Name:RB
Other - Middle Name:
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC, DAOM
Mailing Address - Street 1:6812 PANAMINT ROW UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2812
Mailing Address - Country:US
Mailing Address - Phone:619-325-9974
Mailing Address - Fax:619-399-3266
Practice Address - Street 1:1011 CAMINO DEL RIO S STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3532
Practice Address - Country:US
Practice Address - Phone:619-915-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty