Provider Demographics
NPI:1124238696
Name:IRWIN, ROBERT CARLYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARLYLE
Last Name:IRWIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2888 LOKER AVE E STE 110
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6683
Mailing Address - Country:US
Mailing Address - Phone:619-884-3488
Mailing Address - Fax:760-806-4340
Practice Address - Street 1:2888 LOKER AVE E STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6683
Practice Address - Country:US
Practice Address - Phone:619-884-3488
Practice Address - Fax:760-806-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8940635Medicaid