Individual provider Active NPI

Roman Blueskyes, LMFT

  • Marriage & Family Therapist
  • Culver City, CA
National Provider Identifier
1710011176
Registry record updated Aug 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
43822 Issued in CA
Practice address
3831 Hughes Ave Ste 708
Culver City, CA 90232
Phone
(310) 838-4403
Fax
(888) 231-5872
NPI assigned
Mar 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 43822 CA Primary

Addresses

Primary practice location

3831 Hughes Ave Ste 708
Culver City, CA 90232

Mailing address

3200 Motor Ave
Los Angeles, CA 90034-3710
Phone (310) 837-6647

Other practice location 1

3200 Motor Ave
Los Angeles, CA 90034-3710
Phone (310) 837-6647 ext. 343

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
43822CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533513600000",
    "number": "1710011176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MOTOR AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900343710",
            "telephone_number": "310-837-6647",
            "fax_number": "310-837-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE STE 708",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "90232",
            "telephone_number": "310-838-4403",
            "fax_number": "888-231-5872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Motor Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900343710",
            "country_code": "US",
            "telephone_number": "310-837-6647 x343",
            "fax_number": "310-837-6647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUESKYES",
        "first_name": "ROMAN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2018-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "43822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; 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.