Basic Information
| Provider Information | |||||||||
| NPI: | 1083863518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBLES | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | ALEJANDRA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 981 W ARROW HWY # 191 | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917732410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096679228 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1160 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917405000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263355980 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 01/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 84905 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7368 | 01 | CA | MEDICAL | OTHER | 7708 | 01 | CA | MEDICAL | OTHER | 7184 | 01 | CA | MEDICAL | OTHER | 7667 | 01 | CA | MEDICAL | OTHER |