Healthcare Provider Details

I. General information

NPI: 1154829794
Provider Name (Legal Business Name): MISS JAZMINE CLARE ALMAZAN BUSTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868
US

IV. Provider business mailing address

127 N PARKER ST APT B
ORANGE CA
92868-5024
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95007949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: