Provider Demographics
NPI:1811379365
Name:BASTANI, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BASTANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18124 CULVER DR STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2729
Mailing Address - Country:US
Mailing Address - Phone:949-552-9393
Mailing Address - Fax:949-552-9394
Practice Address - Street 1:18124 CULVER DR STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2729
Practice Address - Country:US
Practice Address - Phone:949-552-9393
Practice Address - Fax:949-552-9394
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5477213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty