Provider Demographics
NPI:1902529258
Name:ROBLEDO, KARINA L (RDN)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:L
Last Name:ROBLEDO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11587 W PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1738
Mailing Address - Country:US
Mailing Address - Phone:623-523-9855
Mailing Address - Fax:
Practice Address - Street 1:11587 W PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1738
Practice Address - Country:US
Practice Address - Phone:623-523-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86145884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered