Basic Information
| Provider Information | |||||||||
| NPI: | 1336674787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBLES | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BAKET ST | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92626 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 BAKET STREET | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926268010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499106767 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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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 | 103K00000X | 1-17-25023 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.