Provider Demographics
NPI:1770517252
Name:ROBINSON, DENNIS JAY (EDD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4872 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2237
Mailing Address - Country:US
Mailing Address - Phone:909-624-1850
Mailing Address - Fax:909-624-1850
Practice Address - Street 1:400 SOUTH SECOND AVE.
Practice Address - Street 2:105
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2805
Practice Address - Country:US
Practice Address - Phone:760-256-5667
Practice Address - Fax:909-624-1850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11012103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR15154Medicare UPIN
CACP11012Medicare ID - Type UnspecifiedSOUTHERN CA. MEDICARE NO.
CA0PL110120Medicare ID - Type UnspecifiedNORTHERN CA MEDICARE NO.