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General NPI Number Information
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NPI Number | 1053371096
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT BASTIEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1240 S WESTLAKE BLVD SUITE 205
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1929
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Country | US
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Telephone | 805-495-0551
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Fax | 805-496-8079
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Provider Business Mailing Address
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Address Line | 1240 S WESTLAKE BLVD SUITE 205
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1929
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Country | US
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Telephone | 805-495-0551
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Fax | 805-496-8079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G68812
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License Number State | CA
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