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General NPI Number Information
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NPI Number | 1427030469
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Entity Type | Individual
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Provider Name | ERNESTINE BUSTAMANTE M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1950 W FRYE RD
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City | CHANDLER
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State | AZ
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Zip | 85224-6255
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Country | US
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Telephone | 480-895-9555
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Fax | 480-961-2332
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Provider Business Mailing Address
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Address Line | 1950 W FRYE RD
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City | CHANDLER
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State | AZ
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Zip | 85224-6255
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Country | US
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Telephone | 480-895-9555
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Fax | 480-895-9494
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30366
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License Number State | AZ
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