Provider Demographics
NPI:1770090185
Name:BUSTAMANTE, RITA MARIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIA
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:18255 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5564
Practice Address - Country:US
Practice Address - Phone:305-234-2186
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9409811163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse