Provider Demographics
NPI:1134592249
Name:GIESEN, ROBIN (MA)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:GIESEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:STE. T-3
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:714-545-5748
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:STE. T-3
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:714-545-5748
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist