Provider Demographics
NPI:1427680719
Name:BASTIEN, RILEY MARIE (MA, APCC11836)
Entity type:Individual
Prefix:MRS
First Name:RILEY
Middle Name:MARIE
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:MA, APCC11836
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8775 AERO DR STE 333
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1756
Mailing Address - Country:US
Mailing Address - Phone:858-384-7035
Mailing Address - Fax:858-384-7815
Practice Address - Street 1:8775 AERO DR STE 333
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1756
Practice Address - Country:US
Practice Address - Phone:858-384-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAAPCC11836101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health