Provider Demographics
NPI:1700015997
Name:KO ROBERSON, CELINE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CELINE
Middle Name:MARIE
Last Name:KO ROBERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CELINE
Other - Middle Name:MARIE
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2250 INDIGO HILLS DR
Mailing Address - Street 2:#3
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7920
Mailing Address - Country:US
Mailing Address - Phone:951-310-3870
Mailing Address - Fax:909-335-5305
Practice Address - Street 1:2250 INDIGO HILLS DR
Practice Address - Street 2:#3
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7920
Practice Address - Country:US
Practice Address - Phone:951-310-3870
Practice Address - Fax:909-335-5305
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist