Provider Demographics
NPI:1659735405
Name:BUSTAMANTE, DANIELA STEEG (PMHNP)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:STEEG
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N ALEXANDRIA AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2875
Mailing Address - Country:US
Mailing Address - Phone:408-464-3359
Mailing Address - Fax:
Practice Address - Street 1:1891 EFFIE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1711
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:323-315-1169
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95207783163WP0808X
101200000X
CA95021294363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist