Provider Demographics
NPI:1730126491
Name:SMITH, ROBERT S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:SMITH
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 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE #122
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:714-229-9900
Mailing Address - Fax:714-229-9959
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE #122
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:714-229-9900
Practice Address - Fax:714-229-9959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY06990103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP6990BMedicare ID - Type Unspecified
CAP77693Medicare UPIN
CAWCP6990AMedicare ID - Type Unspecified