Basic Information
| Provider Information | |||||||||
| NPI: | 1225466063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSTAMANTE | ||||||||
| FirstName: | JESUS | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 CALIFORNIA AVE STE 400B | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933097081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614591900 | ||||||||
| FaxNumber: | 6614591974 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 7TH ST | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932801502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617582263 | ||||||||
| FaxNumber: | 6617588132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2013 | ||||||||
| LastUpdateDate: | 07/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 635265 | CA | N | Nursing Service Providers | Registered Nurse | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA23307 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.