Provider Demographics
NPI:1215172838
Name:SQUIRES, ROBIN A
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:CLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 LARK CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7269
Mailing Address - Country:US
Mailing Address - Phone:805-739-8706
Mailing Address - Fax:805-739-8737
Practice Address - Street 1:212 CARMEN LN STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7771
Practice Address - Country:US
Practice Address - Phone:805-739-8706
Practice Address - Fax:805-739-8737
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9174Medicaid