Provider Demographics
NPI:1720031776
Name:BUSTILLO, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BUSTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SW 62ND PL
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4806
Mailing Address - Country:US
Mailing Address - Phone:305-662-7901
Mailing Address - Fax:305-662-7910
Practice Address - Street 1:7300 SW 62ND PL
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4806
Practice Address - Country:US
Practice Address - Phone:305-662-7901
Practice Address - Fax:305-662-7910
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72915207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA45149Medicare UPIN
FL42324Medicare ID - Type Unspecified