Healthcare Provider Details

I. General information

NPI: 1881520427
Provider Name (Legal Business Name): LUPITA ODALYS BUSTAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MARINA BLVD STE D
PITTSBURG CA
94565-2009
US

IV. Provider business mailing address

455 SHORE RD
BAY POINT CA
94565-1304
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4700
  • Fax:
Mailing address:
  • Phone: 510-273-4700
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: