1679861967 NPI number — DR. ROBIN AMY GANS PSY.D

Table of content: DR. ROBIN AMY GANS PSY.D (NPI 1679861967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679861967 NPI number — DR. ROBIN AMY GANS PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANS
Provider First Name:
ROBIN
Provider Middle Name:
AMY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GANS A PSYCHOLOGICAL CORP.
Provider Other First Name:
ROBIN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679861967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4257 LEMP AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-358-3378
Provider Business Mailing Address Fax Number:
818-358-3379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4257 LEMP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91604-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-358-3378
Provider Business Practice Location Address Fax Number:
818-358-3379
Provider Enumeration Date:
07/20/2011

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: 103T00000X , with the licence number:  17365 , 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)





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