Provider Demographics
NPI:1982804621
Name:ROBLES, BRENDA (BA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:ROBLES
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 1:1832 PURDUE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5590
Mailing Address - Country:US
Mailing Address - Phone:310-529-2521
Mailing Address - Fax:
Practice Address - Street 1:1832 PURDUE AVE APT 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5590
Practice Address - Country:US
Practice Address - Phone:310-529-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health