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NPI Code Detail

MEDICARE: DR. ROBERT MASTIKIAN PSY.D.

MEDICARE: DR. ROBERT MASTIKIAN PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist4473AZ

General Provider Information

NPI Number : 1528453826
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT MASTIKIAN PSY.D.
Provider Business Mailing Address
First Line : 16165 N 83RD AVE STE 200
Second Line :
City : PEORIA
State : AZ
Zip : 85382-5816
Country : US
Telephone Number : 623-256-7266
Fax Number :
Provider Business Practice Location Address
First Line : 16165 N 83RD AVE STE 200
Second Line :
City : PEORIA
State : AZ
Zip : 85382-5816
Country : US
Telephone Number : 623-256-7266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2015
Last Update Date : 04/02/2015

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