Provider Demographics
NPI:1548401102
Name:BUSTAMANTE, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2449
Mailing Address - Country:US
Mailing Address - Phone:323-346-0960
Mailing Address - Fax:323-346-0966
Practice Address - Street 1:2677 1/2 ZOE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK,
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-312-0640
Practice Address - Fax:323-312-0642
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner