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General NPI Number Information
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NPI Number | 1154930667
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Entity Type | Individual
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Provider Name | JENNIFER M BUSTAMANTE MSN, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 15991 RED HILL AVE
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City | TUSTIN
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State | CA
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Zip | 92780-7320
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Country | US
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Telephone | 714-852-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 206 LA PALOMA APT 2
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5147
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Country | US
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Telephone | 310-678-7749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95013167
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95077829
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License Number State | CA
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