Provider Demographics
NPI:1407673452
Name:ROBLES, PEDRO ISMAEL
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ISMAEL
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 1:830 SEABROOK CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1410
Mailing Address - Country:US
Mailing Address - Phone:408-509-6390
Mailing Address - Fax:
Practice Address - Street 1:1530 MERIDIAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5350
Practice Address - Country:US
Practice Address - Phone:628-587-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician