Provider Demographics
NPI:1275521411
Name:ROBINSON, RANDALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 WILLOW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4746
Mailing Address - Country:US
Mailing Address - Phone:559-292-3100
Mailing Address - Fax:559-291-5229
Practice Address - Street 1:3128 WILLOW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4746
Practice Address - Country:US
Practice Address - Phone:559-292-3100
Practice Address - Fax:559-291-5229
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR26296Medicare UPIN
CA00PL55270Medicare ID - Type UnspecifiedPSYCHOLOGY