Provider Demographics
NPI:1790023240
Name:ROBERT E RECORD PHD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT E RECORD PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-904-0679
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-1389
Mailing Address - Country:US
Mailing Address - Phone:714-904-0679
Mailing Address - Fax:
Practice Address - Street 1:875 N BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2606
Practice Address - Country:US
Practice Address - Phone:714-904-0679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6946261QM0801X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)