Provider Demographics
NPI:1972992808
Name:MINTZER DAVIS, ROBIN (PHD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MINTZER DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20101 SW BIRCH ST
Mailing Address - Street 2:#100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1748
Mailing Address - Country:US
Mailing Address - Phone:949-955-9080
Mailing Address - Fax:
Practice Address - Street 1:20101 SW BIRCH ST
Practice Address - Street 2:#100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1748
Practice Address - Country:US
Practice Address - Phone:949-955-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10374103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist