Individual
JOHN FREDERIC BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8110 BIRMINGHAM WAY, SAN DIEGO, CA 92123-2758
(858) 966-5961
Mailing address
3860 CALLE FORTUNADA, SUITE 210, SAN DIEGO, CA 92123-4800
(858) 309-6303
(858) 309-6301
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
G39061
CA
208000000X
Pediatrics Physician
G39061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G390610
—
CA
Enumeration date
11/13/2006
Last updated
08/24/2011
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