MEDICARE: GERMAN PUSTOV PMHNP

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	163W00000X	Registered Nurse	95298784	CA

General Provider Information

NPI Number	:	1790637866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERMAN PUSTOV PMHNP

Provider Business Mailing Address
First Line	:	2870 KAISER DR APT 302
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-7517
Country	:	US
Telephone Number	:	646-637-6521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2870 KAISER DR APT 302
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-7517
Country	:	US
Telephone Number	:	646-637-6521
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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