Provider Demographics
NPI:1467217505
Name:BUSTILLOS MONTERO, CARLOS ANDRES (SA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANDRES
Last Name:BUSTILLOS MONTERO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 NW 7TH ST APT B310
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3253
Mailing Address - Country:US
Mailing Address - Phone:305-342-0594
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 7TH ST APT B310
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3253
Practice Address - Country:US
Practice Address - Phone:305-342-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-143246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant