Individual provider Active NPI

Zuryah Bustamante

  • Clinical Social Worker
  • Phoenix, AZ
National Provider Identifier
1174417455
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-23794 Issued in AZ
Practice address
4646 E Greenway Rd Ste 100
Phoenix, AZ 85032-4805
Phone
(480) 336-3665
NPI assigned
Jun 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-23794 AZ Primary

Addresses

Primary practice location

4646 E Greenway Rd Ste 100
Phoenix, AZ 85032-4805

Mailing address

931 W Mission LN
Phoenix, AZ 85021-3140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20260601001597 AZ Practitioner - Clinical Social Worker 5395215297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

8700 E Via de Ventura
Suite 280
Scottsdale, AZ 85258-4541

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-23794AZMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
FKL Enterprises, LLC CurrentSince Jun 8, 2025 Accepting new patients
FKL Enterprises, LLC CurrentSince Jun 8, 2025 Accepting new patients

Locations

3377 S Price Rd
Ste 105
Chandler, AZ 85248
Phone (480) 674-9220

4646 E Greenway Rd
Ste 100
Phoenix, AZ 85032
Phone (480) 674-9220

2222 W Pinnacle Peak Rd
Ste 220
Phoenix, AZ 85027
Phone (480) 674-9220

8700 E Via de Ventura
Ste 280
Scottsdale, AZ 85258
Phone (480) 210-7266

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778198400000",
    "number": "1174417455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 W MISSION LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850213140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 E GREENWAY RD STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324805",
            "telephone_number": "480-336-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "ZURYAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-03",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-23794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.