Healthcare Provider Details

I. General information

NPI: 1528659596
Provider Name (Legal Business Name): HEATHER RENAE BUSTAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER RENAE RIOS

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE STE 100
BAKERSFIELD CA
93301-3123
US

IV. Provider business mailing address

2618 CLEVELAND WAY
BAKERSFIELD CA
93304-3314
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8310
  • Fax:
Mailing address:
  • Phone: 661-558-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: