Provider Demographics
NPI:1831637198
Name:BUSTILLO, CAMILLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:BUSTILLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:STE 100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3636
Mailing Address - Country:US
Mailing Address - Phone:949-916-1654
Mailing Address - Fax:
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA
Practice Address - Street 2:STE 100
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3636
Practice Address - Country:US
Practice Address - Phone:949-916-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist