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General NPI Number Information
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NPI Number | 1598999047
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Entity Type | Organization
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Legal Business Name | BUSTELO ORTHOPEDIC CENTER, INC.
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 1822 E 4TH AVE SUITE A
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City | HIALEAH
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State | FL
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Zip | 33010-3115
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Country | US
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Telephone | 305-887-5511
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Fax | 305-887-5512
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Provider Business Mailing Address
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Address Line | 1822 E 4TH AVE SUITE A
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City | HIALEAH
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State | FL
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Zip | 33010-3115
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Country | US
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Telephone | 305-887-5511
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Fax | 305-887-5512
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PEDRO R BUSTELO
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Credential | M.D.
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Telephone | 305-887-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME67162
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License Number State | FL
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