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General NPI Number Information
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NPI Number | 1558761205
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Entity Type | Individual
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Provider Name | VALENTINA BUSTAMANTE ATC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 08/31/2014
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Provider Practice Location Address
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Address Line | 1993 AIRPORT RD
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City | FAIRMONT
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State | WV
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Zip | 26554-9138
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Country | US
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Telephone | 305-609-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 DISTRICT DR APT#2112A
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City | MORGANTOWN
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State | WV
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Zip | 26505-2887
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Country | US
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Telephone | 305-609-4315
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL3358
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001272
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License Number State | WV
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