Provider Demographics
NPI:1225149453
Name:PERSI, ROXIE ROBIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROXIE
Middle Name:ROBIN
Last Name:PERSI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N KRAEMER BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5097
Mailing Address - Country:US
Mailing Address - Phone:714-985-0390
Mailing Address - Fax:
Practice Address - Street 1:242 S ORANGE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-985-0390
Practice Address - Fax:714-672-9405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15829Medicare ID - Type Unspecified