Provider Demographics
NPI:1376271213
Name:BUSTO, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BUSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 HARTGLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2026
Mailing Address - Country:US
Mailing Address - Phone:805-341-1596
Mailing Address - Fax:818-495-1460
Practice Address - Street 1:871 HARTGLEN AVE
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2026
Practice Address - Country:US
Practice Address - Phone:805-341-1596
Practice Address - Fax:818-495-1460
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical