Individual provider Active NPI

Robert Alexander Simon, PH.D.

  • Forensic Psychologist
  • San Diego, CA
National Provider Identifier
1245251073
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic PsychologistTaxonomy code 103TF0200X
License
PSY10800 Issued in CA
Practice address
3636 4TH Ave
Suite 210
San Diego, CA 92103-4280
Phone
(619) 220-7680
Fax
(619) 220-7682
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY10800 CA
Clinical Child & Adolescent Psychologist 103TC2200X PSY10800 CA
Forensic Psychologist 103TF0200X PSY10800 CA Primary

Addresses

Primary practice location

3636 4TH Ave
Suite 210
San Diego, CA 92103-4280

Mailing address

3636 5TH Ave
Suite 201
San Diego, CA 92103-4230
Phone (619) 220-7680

Other identifiers 1

IdentifierTypeStateIssuer
PSY108000MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1245251073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 5TH AVE",
            "address_2": "SUITE 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034230",
            "telephone_number": "619-220-7680",
            "fax_number": "619-220-7682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 4TH AVE",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034280",
            "telephone_number": "619-220-7680",
            "fax_number": "619-220-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "ROBERT",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10800",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY10800",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY10800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY108000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.