Provider Demographics
NPI:1932617156
Name:ROBLEDO, CONNIE A (FNP-BC)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:A
Last Name:ROBLEDO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-0925
Mailing Address - Country:US
Mailing Address - Phone:951-729-9016
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:8510 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3583
Practice Address - Country:US
Practice Address - Phone:818-455-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020005363LF0000X
CA95008362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily