Provider Demographics
NPI:1336756162
Name:BUSTAMANTE, ALEXA JEANINE (MS, APCC)
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:JEANINE
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:MS, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5051 CANYON CREST DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6035
Mailing Address - Country:US
Mailing Address - Phone:951-682-1488
Mailing Address - Fax:951-682-1485
Practice Address - Street 1:5051 CANYON CREST DR STE 204
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6035
Practice Address - Country:US
Practice Address - Phone:951-682-1488
Practice Address - Fax:951-682-1485
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health