NPIMap

Organization Active NPI

Black Foundation

  • Psychologist
  • Los Angeles, CA
National Provider Identifier
1376848572
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
ADP190249AN Issued in CA
Legal business name
BLACK FOUNDATION
Practice address
4571 W Washington Blvd
Los Angeles, CA 90016-1717
Phone
(323) 931-3211
NPI assigned
Jan 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Authorized official

Name
Robert BridgesNPI 1558666743
Title
Ceo
Phone
(310) 210-0996

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X ADP190249AN CA Primary

Addresses

Primary practice location

4571 W Washington Blvd
Los Angeles, CA 90016-1717

Mailing address

450 E Silverado Ranch Blvd # 200
Las Vegas, NV 89183-6203
Phone (323) 931-3211

National Provider Directory

National Provider Directory

Locations

4571 W Washington Blvd
Los Angeles, CA 90016
Phone (323) 931-3211

450 E Silverado Ranch Blvd
#200
Las Vegas, NV 89183

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1376848572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E SILVERADO RANCH BLVD # 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891836203",
            "telephone_number": "323-931-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4571 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900161717",
            "telephone_number": "323-931-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-210-0996"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "ADP190249AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.