Provider Demographics
NPI:1255468021
Name:DOBBS, DARREL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:D
Last Name:DOBBS
Suffix:
Gender:M
Credentials:PHD
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 793
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91021-0793
Mailing Address - Country:US
Mailing Address - Phone:818-242-8054
Mailing Address - Fax:
Practice Address - Street 1:2544 EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2318
Practice Address - Country:US
Practice Address - Phone:818-242-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL41761Medicaid
CA00PL41761Medicaid