Provider Demographics
NPI:1205245495
Name:BSTMD, INCORPORATED
Entity type:Organization
Organization Name:BSTMD, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-654-0926
Mailing Address - Street 1:3585 MAPLE ST
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3504
Mailing Address - Country:US
Mailing Address - Phone:805-654-0926
Mailing Address - Fax:805-654-0949
Practice Address - Street 1:3585 MAPLE ST
Practice Address - Street 2:SUITE # 205
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3504
Practice Address - Country:US
Practice Address - Phone:805-654-0926
Practice Address - Fax:805-654-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG755402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75540OtherLICENSE