MEDICARE: WILLIAM BASTIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	16257	CA

General Provider Information

NPI Number	:	1396142642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BASTIAN

Provider Business Mailing Address
First Line	:	611 S PALM CANYON DR # 7558
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-7213
Country	:	US
Telephone Number	:	319-561-6798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 E. PALM CANYON DRIVE
Second Line	:	STE. 315
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-7213
Country	:	US
Telephone Number	:	319-561-6798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	05/27/2016

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