Provider Demographics
NPI:1578779476
Name:ROTHSTEIN, BUSHRA (PHD)
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:
Last Name:ROTHSTEIN
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 1:10505 CAMARILLO ST
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1527
Mailing Address - Country:US
Mailing Address - Phone:310-535-3030
Mailing Address - Fax:
Practice Address - Street 1:10505 CAMARILLO ST
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-1527
Practice Address - Country:US
Practice Address - Phone:310-535-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8788106H00000X
NY000779102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA13172462OtherWRITER'S GUILD HEALTH