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General NPI Number Information
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NPI Number | 1558809855
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Entity Type | Individual
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Provider Name | ANGIE MARY BUSTAMANTE
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Gender | Female
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1031 SW 124TH CT
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City | MIAMI
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State | FL
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Zip | 33184-2458
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Country | US
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Telephone | 786-294-5875
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 SW 124TH CT
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City | MIAMI
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State | FL
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Zip | 33184-2458
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Country | US
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Telephone | 786-294-5875
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9551808
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License Number State | FL
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