Basic Information
| Provider Information | |||||||||
| NPI: | 1245795665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEKIN | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 TRIESTE DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921073949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199921488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4450 KEARNY VILLA RD | ||||||||
| Address2: | #116 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 110405 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.