Healthcare Provider Details

I. General information

NPI: 1285484402
Provider Name (Legal Business Name): MARIA VICTORIA BUSTOS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA VICTORIA YANEZ

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NIBLICK RD
PASO ROBLES CA
93446-4858
US

IV. Provider business mailing address

21601 E 32ND PL S
BROKEN ARROW OK
74014-1163
US

V. Phone/Fax

Practice location:
  • Phone: 805-769-1000
  • Fax:
Mailing address:
  • Phone: 918-282-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6428
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: