Provider Demographics
NPI:1063550267
Name:ROBINSON, SOPHIA ANASTASIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:ANASTASIA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17451 BASTANCHURY RD
Mailing Address - Street 2:STE. 204-13
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1857
Mailing Address - Country:US
Mailing Address - Phone:714-779-2939
Mailing Address - Fax:
Practice Address - Street 1:17451 BASTANCHURY RD
Practice Address - Street 2:STE. 204-13
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-779-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14286103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14286AMedicare ID - Type Unspecified