Provider Demographics
NPI:1467510040
Name:BUSTOS, ADELAIDA E (MD)
Entity Type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:E
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N ALVARADO ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4016
Mailing Address - Country:US
Mailing Address - Phone:213-413-7888
Mailing Address - Fax:213-413-5986
Practice Address - Street 1:711 N ALVARADO ST STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4016
Practice Address - Country:US
Practice Address - Phone:213-413-7888
Practice Address - Fax:213-413-5986
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA363482085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36348Medicare UPIN
CAA36348Medicare UPIN