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General NPI Number Information
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NPI Number | 1912402884
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Entity Type | Individual
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Provider Name | CHRISTIAN EDGAR BUSTAMANTE MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | NMRTC/NAVAL HOSPITAL YOKOSUKA JAPAN INAOKACHO, 82
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City | YOKOSUKA
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State | KANAGAWA
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Zip | 238-0001
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Country | JP
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Telephone | 46-816-7144
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Fax |
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Provider Business Mailing Address
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Address Line | 2523 12TH SQ SW
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City | VERO BEACH
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State | FL
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Zip | 32968-5065
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Country | US
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Telephone | 772-559-2206
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S6580
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME145628
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License Number State | FL
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