Provider Demographics
NPI:1124233945
Name:BUSTAMANTE, CHRISTOPHER D (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:BUSTAMANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:168 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2601
Mailing Address - Country:US
Mailing Address - Phone:310-233-3202
Mailing Address - Fax:
Practice Address - Street 1:168 W CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2601
Practice Address - Country:US
Practice Address - Phone:310-233-3202
Practice Address - Fax:310-233-3208
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH14407207Q00000X
CAC181092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077079Medicaid