Provider Demographics
NPI:1073508594
Name:VANDE STEEG, ROBERT L (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:VANDE STEEG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 KATELLA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3434
Mailing Address - Country:US
Mailing Address - Phone:562-810-2740
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE
Practice Address - Street 2:STE 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3434
Practice Address - Country:US
Practice Address - Phone:562-810-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q48580Medicare UPIN
CACP19764Medicare ID - Type Unspecified