Healthcare Provider Details

I. General information

NPI: 1033722384
Provider Name (Legal Business Name): OSVALDO BASTIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OZ B PSY.D.

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 E BRIER DR STE 200
SAN BERNARDINO CA
92408-2847
US

IV. Provider business mailing address

658 E BRIER DR STE 200
SAN BERNARDINO CA
92408-2847
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-0700
  • Fax: 909-387-7611
Mailing address:
  • Phone: 909-501-0700
  • Fax: 909-387-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberWAIVERED
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: