Provider Demographics
NPI:1720231830
Name:BUSTOS-NAVARRO, AMPARO GUDINO
Entity Type:Individual
Prefix:MS
First Name:AMPARO
Middle Name:GUDINO
Last Name:BUSTOS-NAVARRO
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 1:21455 BIRCH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2165
Mailing Address - Country:US
Mailing Address - Phone:510-383-0414
Mailing Address - Fax:
Practice Address - Street 1:21455 BIRCH ST
Practice Address - Street 2:STE 201
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2165
Practice Address - Country:US
Practice Address - Phone:510-383-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 58632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health