Provider Demographics
NPI:1932381332
Name:BUSTOS, ANTONIO MUSNI JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MUSNI
Last Name:BUSTOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 LONDON ST
Mailing Address - Street 2:AMB RESIDENTIAL CARE HOME
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2028
Mailing Address - Country:US
Mailing Address - Phone:415-452-3172
Mailing Address - Fax:
Practice Address - Street 1:219 LONDON ST
Practice Address - Street 2:AMB RESIDENTIAL CARE HOME
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2028
Practice Address - Country:US
Practice Address - Phone:415-452-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness