Provider Demographics
NPI:1659059293
Name:ROBINSON, TIMOTHY ZAIRE GIBSON FRANK
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ZAIRE GIBSON FRANK
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZAIRE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1821 E 5TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2015
Mailing Address - Country:US
Mailing Address - Phone:562-702-4083
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE STE C
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1612
Practice Address - Country:US
Practice Address - Phone:714-879-4274
Practice Address - Fax:714-879-2274
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician