Healthcare Provider Details

I. General information

NPI: 1225963630
Provider Name (Legal Business Name): NATASHA H BUSANSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 E 14TH ST
SAN LEANDRO CA
94578-2709
US

IV. Provider business mailing address

2938 AVALON AVE
BERKELEY CA
94705-1448
US

V. Phone/Fax

Practice location:
  • Phone: 151-022-0957
  • Fax:
Mailing address:
  • Phone: 510-703-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: