Healthcare Provider Details

I. General information

NPI: 1659735405
Provider Name (Legal Business Name): DANIELA STEEG BUSTAMANTE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 EFFIE ST
LOS ANGELES CA
90026-1711
US

IV. Provider business mailing address

528 N ALEXANDRIA AVE APT 1B
LOS ANGELES CA
90004-2875
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-2000
  • Fax: 323-315-1169
Mailing address:
  • Phone: 408-464-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95207783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: