Provider Demographics
NPI:1215287123
Name:BASTIANON, CINDY LEE (PT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:BASTIANON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59462 RD. 225
Mailing Address - Street 2:SPC 1
Mailing Address - City:NORTH FORK
Mailing Address - State:CA
Mailing Address - Zip Code:93643
Mailing Address - Country:US
Mailing Address - Phone:559-741-5089
Mailing Address - Fax:
Practice Address - Street 1:59462 RD. 225
Practice Address - Street 2:SPC 1
Practice Address - City:NORTH FORK
Practice Address - State:CA
Practice Address - Zip Code:93643
Practice Address - Country:US
Practice Address - Phone:559-741-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24195374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician