Provider Demographics
NPI:1669211520
Name:BUSTOS, MARIA IRMA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:IRMA
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 PARAMUS RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1737
Mailing Address - Country:US
Mailing Address - Phone:201-527-0233
Mailing Address - Fax:
Practice Address - Street 1:593 PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1737
Practice Address - Country:US
Practice Address - Phone:201-527-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353864163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical