Provider Demographics
NPI:1568217404
Name:BUSTAMENTE, BIANCA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:LYNN
Last Name:BUSTAMENTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1632
Mailing Address - Country:US
Mailing Address - Phone:818-274-2570
Mailing Address - Fax:
Practice Address - Street 1:455 OCONNOR DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1632
Practice Address - Country:US
Practice Address - Phone:818-274-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program