Provider Demographics
NPI:1952466344
Name:HESTIR, BLUFORD BRADFORD III (PHD)
Entity Type:Individual
Prefix:DR
First Name:BLUFORD
Middle Name:BRADFORD
Last Name:HESTIR
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 BERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3604
Mailing Address - Country:US
Mailing Address - Phone:510-535-0498
Mailing Address - Fax:
Practice Address - Street 1:10 DOUGLAS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4077
Practice Address - Country:US
Practice Address - Phone:925-313-1150
Practice Address - Fax:925-313-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18093103TC0700X, 103TF0200X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235OtherCLINICIAN STAFF NUMBER