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NPI Code Detail

MEDICARE: JERROLD C BUSTOS MD, INC

MEDICARE: JERROLD C BUSTOS MD, INC
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
1207L00000XAnesthesiology PhysicianA85842CA

General Provider Information

NPI Number : 1548551930
Entity Type Code : Organization
Provider Name (Legal Business Name) : JERROLD C BUSTOS MD, INC
Provider Business Mailing Address
First Line : 5 HOLLAND STE 101
Second Line :
City : IRVINE
State : CA
Zip : 92618-2568
Country : US
Telephone Number : 949-588-2190
Fax Number : 949-588-2199
Provider Business Practice Location Address
First Line : 5700 SAN FERNANDO RD
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2104
Country : US
Telephone Number : 818-637-7766
Fax Number : 818-956-1706
Authorized Official
Title or Position : PRESIDENT
Name : JERROLD C BUSTOS
Credential : MD
Telephone Number : 949-588-2190
Provider Enumeration Date : 04/20/2011
Last Update Date : 04/20/2011

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