Provider Demographics
NPI:1255771135
Name:BUSTOS, CRISTINA ELENA (PHD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELENA
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:BUSTOS OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LEGAL NAME
Mailing Address - Street 1:PO BOX 5362
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-5362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-6641
Practice Address - Country:US
Practice Address - Phone:760-643-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25308103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical