MEDICARE: COMPLETE CARE FOR WOMEN PC

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1942387683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE FOR WOMEN PC

Provider Business Mailing Address
First Line	:	1455 W CHANDLER BLVD
Second Line	:	BLDG B SUITE 11
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6177
Country	:	US
Telephone Number	:	480-991-6249
Fax Number	:	480-991-4249

Provider Business Practice Location Address
First Line	:	1455 W CHANDLER BLVD
Second Line	:	BLDG B SUITE 11
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6177
Country	:	US
Telephone Number	:	480-991-6249
Fax Number	:	480-991-4249

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERNESTINE A BUSTAMANTE
Credential	:	MD
Telephone Number	:	480-991-6249

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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Directions to “COMPLETE CARE FOR WOMEN PC ” Practice Location

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