Provider Demographics
NPI:1174058242
Name:BUSHFAN, OJORE LATEEF (MFTI)
Entity type:Individual
Prefix:
First Name:OJORE
Middle Name:LATEEF
Last Name:BUSHFAN
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TARO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-4623
Mailing Address - Country:US
Mailing Address - Phone:619-767-0118
Mailing Address - Fax:
Practice Address - Street 1:1600 N CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1109
Practice Address - Country:US
Practice Address - Phone:619-956-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist