Healthcare Provider Details

I. General information

NPI: 1659553253
Provider Name (Legal Business Name): DORIS PABLO-BUSTOS, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 09/02/2025
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 VARNUM ST NE PMB 202
WASHINGTON DC
20017-2151
US

IV. Provider business mailing address

1140 VARNUM ST NE PMB 202
WASHINGTON DC
20017-2151
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-6430
  • Fax: 202-269-6598
Mailing address:
  • Phone: 202-269-6430
  • Fax: 202-269-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE YRASTORZA
Title or Position: RCM
Credential:
Phone: 202-269-6430