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General NPI Number Information
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NPI Number | 1942345632
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Entity Type | Individual
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Provider Name | PATRICIA RANDOLPH MA, PH.D
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2900 ADAMS ST
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City | RIVERSIDE
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State | CA
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Zip | 92504-4335
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Country | US
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Telephone | 951-205-5883
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Fax | 951-898-9858
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Provider Business Mailing Address
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Address Line | 2201 SANTA ANITA AVE
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City | ALTADENA
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State | CA
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Zip | 91001-2918
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Country | US
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Telephone | 626-482-4021
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Fax | 951-898-9858
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC25109
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License Number State | CA
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