Provider Demographics
NPI:1700451200
Name:ROBLES, LEONARDO AGUSTIN
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:AGUSTIN
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 1:6824 LOGUE LN
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7241
Mailing Address - Country:US
Mailing Address - Phone:254-327-2001
Mailing Address - Fax:254-875-0479
Practice Address - Street 1:6824 LOGUE LN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7241
Practice Address - Country:US
Practice Address - Phone:254-327-2001
Practice Address - Fax:254-875-0479
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician