Provider Demographics
NPI:1871712828
Name:SOFFER, ROBIN SUE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:SUE
Last Name:SOFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33205 LARK WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1157
Mailing Address - Country:US
Mailing Address - Phone:510-324-1990
Mailing Address - Fax:
Practice Address - Street 1:933 SHORELINE DR APT 406
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5990
Practice Address - Country:US
Practice Address - Phone:510-324-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG745192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E82286Medicare UPIN