Provider Demographics
NPI:1770670093
Name:ROBYNNE RUDIN, PH.D.
Entity Type:Organization
Organization Name:ROBYNNE RUDIN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYNNE
Authorized Official - Middle Name:RUDIN
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-302-0030
Mailing Address - Street 1:1601 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE290
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3213
Mailing Address - Country:US
Mailing Address - Phone:310-302-0030
Mailing Address - Fax:
Practice Address - Street 1:1601 PACIFIC COAST HWY
Practice Address - Street 2:SUITE290
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3213
Practice Address - Country:US
Practice Address - Phone:310-302-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty