Healthcare Provider Details

I. General information

NPI: 1366911448
Provider Name (Legal Business Name): SARAH CATHERINE BUSTAMANTE B.A., C-IAYT, SBD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 11/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 NW 16TH ST STE A
OKLAHOMA CITY OK
73106-2078
US

IV. Provider business mailing address

1705 NW 35TH ST
OKLAHOMA CITY OK
73118-3217
US

V. Phone/Fax

Practice location:
  • Phone: 405-788-7348
  • Fax:
Mailing address:
  • Phone: 405-788-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: