Provider Demographics
NPI:1891899183
Name:RANDALL, ROBIN RICARDO (MD MPH)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RICARDO
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 VICENTE STREET
Mailing Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2923
Mailing Address - Country:US
Mailing Address - Phone:415-681-3211
Mailing Address - Fax:415-664-7094
Practice Address - Street 1:1801 VICENTE STREET
Practice Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:415-681-3211
Practice Address - Fax:415-664-7094
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA541032084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry