Provider Demographics
NPI:1598999047
Name:BUSTELO ORTHOPEDIC CENTER, INC.
Entity Type:Organization
Organization Name:BUSTELO ORTHOPEDIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUSTELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-887-5511
Mailing Address - Street 1:1822 E 4TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3115
Mailing Address - Country:US
Mailing Address - Phone:305-887-5511
Mailing Address - Fax:305-887-5512
Practice Address - Street 1:1822 E 4TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3115
Practice Address - Country:US
Practice Address - Phone:305-887-5511
Practice Address - Fax:305-887-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67162261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261041800Medicaid
FLF91658Medicare UPIN