Provider Demographics
NPI:1497708762
Name:HANSINK, RAYMOND L (PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:HANSINK
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 1:29222 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1045
Mailing Address - Country:US
Mailing Address - Phone:949-933-3556
Mailing Address - Fax:949-481-1149
Practice Address - Street 1:29222 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1041
Practice Address - Country:US
Practice Address - Phone:949-933-3556
Practice Address - Fax:949-481-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY160870Medicaid
CAS72780Medicare UPIN
CANPI - 1497708762Medicare PIN
CAPSY160870Medicaid