Kristen Rene Bustillos Fragoso, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

100098 Issued in CA

Practice address

425 Edgewood Dr
Fillmore, CA 93015-1846

Phone

(818) 356-5942

NPI assigned

Jun 18, 2017

Last updated

May 22, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1013447457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 EDGEWOOD DR",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151846",
            "telephone_number": "818-356-5942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 EDGEWOOD DR",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151846",
            "telephone_number": "818-356-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAGOSO",
        "first_name": "KRISTEN RENE",
        "middle_name": "BUSTILLOS",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-18",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ACSW78038",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "100098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fillmore Area Transit Corp (Sun Shuttle and Transit)
• Fillmore Convalescent Center, LLC
• Fillmore Country Club
• Fillmore Unified School District
• Melissa Flores
• Garfield Beach CVS LLC
• Alvaro Nathan Garnica
• Olivia Gonzalez, PT, DPT
• Amalia Granados, PPS CREDENTIAL
• Greenfield Care Center of Fillmore LLC

• Clinical Social Worker in Fillmore, CA
• Providers in Fillmore, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.