Provider Demographics
NPI:1891717070
Name:ROBINSON, RANDY JON (PHD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:JON
Last Name:ROBINSON
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 1:15706 POMERADO RD
Mailing Address - Street 2:STE. 210
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2067
Mailing Address - Country:US
Mailing Address - Phone:858-451-9400
Mailing Address - Fax:858-451-9467
Practice Address - Street 1:15706 PROMARDO RD.
Practice Address - Street 2:STE. 210
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-451-9400
Practice Address - Fax:858-451-9467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical