Healthcare Provider Details

I. General information

NPI: 1275521411
Provider Name (Legal Business Name): RANDALL ROBINSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 WILLOW AVE SUITE 102
CLOVIS CA
93612-4746
US

IV. Provider business mailing address

3128 WILLOW AVE SUITE 102
CLOVIS CA
93612-4746
US

V. Phone/Fax

Practice location:
  • Phone: 559-292-3100
  • Fax: 559-291-5229
Mailing address:
  • Phone: 559-292-3100
  • Fax: 559-291-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: