Healthcare Provider Details

I. General information

NPI: 1972223949
Provider Name (Legal Business Name): ROBIN RENEE ENSOR KOPF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

16 PACIFIC GROVE DR
ALISO VIEJO CA
92656-4216
US

V. Phone/Fax

Practice location:
  • Phone: 949-279-4981
  • Fax:
Mailing address:
  • Phone: 949-742-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: