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General NPI Number Information
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NPI Number | 1265092456
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Entity Type | Individual
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Provider Name | EILYN GABRIELA BUSTAMANTE
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 6229 66TH ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-5025
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Country | US
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Telephone | 727-623-9913
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Fax | 727-803-6852
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Provider Business Mailing Address
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Address Line | 1701 CENTRAL AVE UNIT 229
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City | ST PETERSBURG
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State | FL
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Zip | 33713-8969
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Country | US
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Telephone | 614-441-2271
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME167237
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License Number State | FL
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