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General NPI Number Information
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NPI Number | 1275635559
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Entity Type | Individual
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Provider Name | DORIS V PABLO-BUSTOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1140 VARNUM ST NE PMB 202
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City | WASHINGTON
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State | DC
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Zip | 20017-2151
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Country | US
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Telephone | 202-269-6430
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Fax | 202-269-6598
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Provider Business Mailing Address
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Address Line | 1140 VARNUM ST NE PMB 202
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City | WASHINGTON
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State | DC
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Zip | 20017-2151
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Country | US
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Telephone | 202-269-6430
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Fax | 202-269-6598
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101056019
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD30307
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | D0058776
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | MD30307
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0101056019
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MD30307
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License Number State | DC
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Taxonomy #7
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0101056019
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | D0058776
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License Number State | MD
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Taxonomy #9
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MD30307
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License Number State | DC
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Taxonomy #10
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0101056019
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License Number State | VA
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Taxonomy #11
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | D0058776
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License Number State | MD
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Taxonomy #12
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MD30307
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License Number State | DC
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Taxonomy #13
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 0101056019
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License Number State | VA
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Taxonomy #14
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | D0058776
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License Number State | MD
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Taxonomy #15
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD30307
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License Number State | DC
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