Provider Demographics
NPI:1730645979
Name:PABUSTAN, LOUVELLA NUQUI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LOUVELLA
Middle Name:NUQUI
Last Name:PABUSTAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15580 BAYPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2803
Mailing Address - Country:US
Mailing Address - Phone:510-305-7224
Mailing Address - Fax:
Practice Address - Street 1:889 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6115
Practice Address - Country:US
Practice Address - Phone:510-770-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010934363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner