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General NPI Number Information
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NPI Number | 1255103966
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Entity Type | Individual
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Provider Name | ANTHONY BUSTAMANTE
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Gender | Male
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 101 CIRBY HILLS DR BLDG A
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City | ROSEVILLE
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State | CA
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Zip | 95678-4360
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Country | US
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Telephone | 916-788-8144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1011
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City | DAVIS
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State | CA
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Zip | 95617-1011
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Country | US
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Telephone | 530-601-0026
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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