Provider Demographics
NPI:1851819122
Name:ROBERT, RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:ROBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1763
Mailing Address - Country:US
Mailing Address - Phone:949-336-2535
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE STE 470
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4233
Practice Address - Country:US
Practice Address - Phone:949-336-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851819122Medicaid