Provider Demographics
NPI:1710296470
Name:PADILLA BUSTOS, LIZBETH
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:PADILLA BUSTOS
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 1:2309 DALY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2230
Mailing Address - Country:US
Mailing Address - Phone:323-222-4591
Mailing Address - Fax:323-222-4614
Practice Address - Street 1:2309 DALY ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2230
Practice Address - Country:US
Practice Address - Phone:323-222-4591
Practice Address - Fax:323-222-4614
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program