Provider Demographics
NPI:1659138048
Name:ROBLES, REGINA S (MSW INTERN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:S
Last Name:ROBLES
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:S
Other - Last Name:LOWENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:1604 E RETFORD ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2815
Mailing Address - Country:US
Mailing Address - Phone:323-334-7299
Mailing Address - Fax:
Practice Address - Street 1:180 VIA VERDE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3993
Practice Address - Country:US
Practice Address - Phone:909-599-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA43382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant