Healthcare Provider Details

I. General information

NPI: 1396990149
Provider Name (Legal Business Name): ARMIDA IGLESIAS BUSTAMANTE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E 4TH ST SUITE 148
SANTA ANA CA
92705-3940
US

IV. Provider business mailing address

2030 E 4TH ST SUITE 148
SANTA ANA CA
92705-3940
US

V. Phone/Fax

Practice location:
  • Phone: 714-335-0147
  • Fax:
Mailing address:
  • Phone: 714-335-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20893
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY20893
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY20893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: