Provider Demographics
NPI:1821352840
Name:BUZZINI, TRISTAN COLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:COLE
Last Name:BUZZINI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32050
Mailing Address - Street 2:CALIFORNIA HEALTHCARE FACILITY
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95213-2050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7707 AUSTIN RD
Practice Address - Street 2:CALIFORNIA HEALTHCARE FACILITY
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-8312
Practice Address - Country:US
Practice Address - Phone:650-962-4428
Practice Address - Fax:650-962-4428
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27973103TC0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical