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NPI Code Detail

MEDICARE: MR. EREN ROUBAL PH.D.

MEDICARE: MR. EREN ROUBAL PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2103T00000XPsychologist10840553-2501UT

General Provider Information

NPI Number : 1639485568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EREN ROUBAL PH.D.
Provider Business Mailing Address
First Line : 919 W NEWPORT AVE
Second Line : APT 1
City : CHICAGO
State : IL
Zip : 60657-2639
Country : US
Telephone Number : 612-203-2927
Fax Number :
Provider Business Practice Location Address
First Line : 1 BOONE RD
Second Line :
City : BREMERTON
State : WA
Zip : 98312-1894
Country : US
Telephone Number : 360-475-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2010
Last Update Date : 03/07/2022

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