Provider Demographics
NPI:1326503962
Name:BASTIEN CABRERA, GUSTAVO CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:CHRISTIAN
Last Name:BASTIEN CABRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9466 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6518
Mailing Address - Country:US
Mailing Address - Phone:562-341-2876
Mailing Address - Fax:
Practice Address - Street 1:2405 TRANSPORTATION AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6664
Practice Address - Country:US
Practice Address - Phone:619-474-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist