MEDICARE: GABRIELLA BUSTILLOS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1467308767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA BUSTILLOS

Provider Business Mailing Address
First Line	:	235 MARTIN LUTHER KING JR WAY
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-3275
Country	:	US
Telephone Number	:	571-552-0294
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 MARTIN LUTHER KING JR WAY
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22807-3275
Country	:	US
Telephone Number	:	571-552-0294
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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