Provider Demographics
NPI:1154575876
Name:CORB, ROBERT ELDRIDGE JR (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELDRIDGE
Last Name:CORB
Suffix:JR
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:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-0912
Mailing Address - Country:US
Mailing Address - Phone:562-773-7413
Mailing Address - Fax:
Practice Address - Street 1:JOHN WOODEN CTR W
Practice Address - Street 2:BOX 951556
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:313-825-0768
Practice Address - Fax:310-206-7365
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17422103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports