Individual
INGMAR NIELS BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
(888) 539-8781
Mailing address
FILE 57326, LOS ANGELES, CA 90074-7326
(800) 926-8273
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
208879
CA
207V00000X
Obstetrics & Gynecology Physician
STUDENT
WI
Other
Enumeration date
03/24/2022
Last updated
05/05/2026
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