Healthcare Provider Details

I. General information

NPI: 1053558544
Provider Name (Legal Business Name): BRENDA ROBERTSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22939 HAWTHORNE BLVD STE 313
TORRANCE CA
90505-3680
US

IV. Provider business mailing address

PO BOX 1039
TORRANCE CA
90505-0039
US

V. Phone/Fax

Practice location:
  • Phone: 213-598-6535
  • Fax:
Mailing address:
  • Phone: 213-598-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA113050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: