Provider Demographics
NPI:1053503284
Name:BUSTAMANTE, CECILIA A (PA)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:A
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:SUITE # 21
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1800
Mailing Address - Country:US
Mailing Address - Phone:561-616-3939
Mailing Address - Fax:561-616-3934
Practice Address - Street 1:3345 BURNS RD STE 302
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4321
Practice Address - Country:US
Practice Address - Phone:561-622-7661
Practice Address - Fax:561-622-4651
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant