Provider Demographics
NPI:1700444908
Name:ROBLEDO, GWENDOLYN NAOMI (BA)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:NAOMI
Last Name:ROBLEDO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 JADED IRIS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3978
Mailing Address - Country:US
Mailing Address - Phone:702-592-9518
Mailing Address - Fax:
Practice Address - Street 1:7730 W SAHARA AVE STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2753
Practice Address - Country:US
Practice Address - Phone:702-660-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVLBA0853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician