Basic Information
| Provider Information | |||||||||
| NPI: | 1013261932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISH | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | PHYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3371 GLENDALE BLVD | ||||||||
| Address2: | UNIT 133 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900391825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134841186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 522 S SAN PEDRO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900132102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134864050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2012 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY14143 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.