MEDICARE: CRISTINA L BUSTAMANTE AMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1013871953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA L BUSTAMANTE AMFT

Provider Business Mailing Address
First Line	:	541 LEDGE ST
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2840
Country	:	US
Telephone Number	:	760-583-2524
Fax Number	:	760-593-2430

Provider Business Practice Location Address
First Line	:	334 VIA VERA CRUZ STE 255
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2642
Country	:	US
Telephone Number	:	760-583-2524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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