Provider Demographics
NPI:1891980223
Name:BUSTAMANTE, SYLVIA M (PA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1920 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3106
Mailing Address - Country:US
Mailing Address - Phone:956-584-3353
Mailing Address - Fax:956-584-3253
Practice Address - Street 1:1920 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-584-3353
Practice Address - Fax:956-584-3253
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical