Basic Information
| Provider Information | |||||||||
| NPI: | 1568411809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSTAMANTE | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | FABIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3369 PINE RIDGE RD UNIT 203 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341093932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396312662 | ||||||||
| FaxNumber: | 2396318597 | ||||||||
| Practice Location | |||||||||
| Address1: | 3369 PINE RIDGE RD UNIT 203 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341093932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396312662 | ||||||||
| FaxNumber: | 2396318597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME83044 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.