Provider Demographics
NPI:1871322438
Name:PENA-ROBLES, THRISSIA L (171400000X 174H0000X)
Entity type:Individual
Prefix:
First Name:THRISSIA
Middle Name:L
Last Name:PENA-ROBLES
Suffix:
Gender:F
Credentials:171400000X 174H0000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 BELSHAW AVE # EXCA1377
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3506
Mailing Address - Country:US
Mailing Address - Phone:855-442-5885
Mailing Address - Fax:
Practice Address - Street 1:20500 BELSHAW AVE # EXCA1377
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3506
Practice Address - Country:US
Practice Address - Phone:855-442-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
D174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach