Provider Demographics
NPI:1154341386
Name:BASTIEN, ROCHELLE THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:THERESA
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 FRIARS RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5899
Mailing Address - Country:US
Mailing Address - Phone:619-285-1323
Mailing Address - Fax:619-284-6770
Practice Address - Street 1:9040 FRIARS RD
Practice Address - Street 2:STE 420
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5899
Practice Address - Country:US
Practice Address - Phone:619-285-1323
Practice Address - Fax:619-284-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6159527Medicare UPIN