Healthcare Provider Details

I. General information

NPI: 1578683363
Provider Name (Legal Business Name): ROBIN LESLIE SIOTA BREEDING PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 PERRIN BEITEL RD STE 300
SAN ANTONIO TX
78217-3144
US

IV. Provider business mailing address

10807 PERRIN BEITEL RD STE 300
SAN ANTONIO TX
78217-3144
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7862
  • Fax:
Mailing address:
  • Phone: 210-245-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19427
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: