Active NPI
Bo Dean Robertson
- Psychologist
- El Segundo, CA
National Provider Identifier
1720676323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 483 N Aviation Blvd BLDG 210
El Segundo, CA 90245-2808 - Phone
- (310) 653-6860
- NPI assigned
- Jan 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
483 N Aviation Blvd BLDG 210
El Segundo, CA 90245-2808
Mailing address
1983 Spring Ridge Dr
Xenia, OH 45385-9800
Phone (808) 352-3073
Other practice location 1
4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433-5529
Phone (937) 257-1368
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1720676323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1983 SPRING RIDGE DR",
"city": "XENIA",
"state": "OH",
"postal_code": "453859800",
"telephone_number": "808-352-3073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD BLDG 210",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-6860"
}
],
"practiceLocations": [
{
"address_1": "4881 Sugar Maple Dr",
"address_purpose": "LOCATION",
"city": "Wright Patterson AFB",
"state": "OH",
"postal_code": "454335529",
"country_code": "US",
"telephone_number": "937-257-1368",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTSON",
"first_name": "BO",
"middle_name": "DEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-08",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.