Healthcare Provider Details

I. General information

NPI: 1821352840
Provider Name (Legal Business Name): TRISTAN COLE BUZZINI PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD CALIFORNIA HEALTHCARE FACILITY
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

PO BOX 32050 CALIFORNIA HEALTHCARE FACILITY
STOCKTON CA
95213-2050
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4428
  • Fax: 650-962-4428
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: