Basic Information
| Provider Information | |||||||||
| NPI: | 1053503284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSTAMANTE | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 PRESIDENTIAL WAY | ||||||||
| Address2: | SUITE # 21 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334011800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616163939 | ||||||||
| FaxNumber: | 5616163934 | ||||||||
| Practice Location | |||||||||
| Address1: | 3345 BURNS RD STE 302 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616227661 | ||||||||
| FaxNumber: | 5616224651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2007 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA2084 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.