Healthcare Provider Details

I. General information

NPI: 1508972753
Provider Name (Legal Business Name): ROBIN MARIE KIETZMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N EL MOLINO AVE
PASADENA CA
91101
US

IV. Provider business mailing address

447 N EL MOLINO AVE.
PASADENA CA
91101
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8480
  • Fax: 626-577-8978
Mailing address:
  • Phone: 626-577-8480
  • Fax: 626-577-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: