Healthcare Provider Details

I. General information

NPI: 1487271300
Provider Name (Legal Business Name): PATIENT PAYMENT AGENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 STORY RD STE 12
SAN JOSE CA
95122-2604
US

IV. Provider business mailing address

1009 E CAPITOL EXPY STE 710
SAN JOSE CA
95121-2415
US

V. Phone/Fax

Practice location:
  • Phone: 408-614-7182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESUS BRYAN BUSTOS
Title or Position: COO
Credential:
Phone: 650-555-1212