Provider Demographics
NPI:1083219760
Name:BUSTILLOS, LUZ (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:BUSTILLOS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W CAMERON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2726
Mailing Address - Country:US
Mailing Address - Phone:626-653-9913
Mailing Address - Fax:
Practice Address - Street 1:1515 W CAMERON AVE STE 210
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2726
Practice Address - Country:US
Practice Address - Phone:626-653-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner