MEDICARE: LIANA BUSTILLO RD

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1245194869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA BUSTILLO RD

Provider Business Mailing Address
First Line	:	5437 ELLSWORTH AVE APT 207
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N HIGHLAND AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-2526
Country	:	US
Telephone Number	:	412-362-6622
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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