Provider Demographics
NPI:1225154222
Name:BANTUGAN-BOHAN, CHRISTY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:C
Last Name:BANTUGAN-BOHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 OBERLIN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1737
Mailing Address - Country:US
Mailing Address - Phone:760-652-4035
Mailing Address - Fax:760-652-4035
Practice Address - Street 1:5665 OBERLIN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1737
Practice Address - Country:US
Practice Address - Phone:760-652-4035
Practice Address - Fax:760-652-4035
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14498CMedicare ID - Type Unspecified