1770836603 NPI number — DR. ROBYN CANNON PEARL PSYD

Table of content: DR. ROBYN CANNON PEARL PSYD (NPI 1770836603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770836603 NPI number — DR. ROBYN CANNON PEARL PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANNON PEARL
Provider First Name:
ROBYN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEARL
Provider Other First Name:
ROBYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1770836603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 322
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENTFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-322-0357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 OAK ST
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-2947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-322-0357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  25174 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)