Bustillo Medical Corp, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G51357 Issued in CA

Legal business name

BUSTILLO MEDICAL CORP, INC

Practice address

9900 Talbert Ave
Suite 202
Fountain Valley, CA 92708-5153

Phone

(714) 378-5552

Fax

(714) 378-5541

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gerardo Bustillo, M.D.

Title

President

Phone

(714) 378-5552

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1316169105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 TALBERT AVE",
            "address_2": "SUITE 202",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085153",
            "telephone_number": "714-378-5552",
            "fax_number": "714-378-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 TALBERT AVE",
            "address_2": "SUITE 202",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085153",
            "telephone_number": "714-378-5552",
            "fax_number": "714-378-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSTILLO MEDICAL CORP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "BUSTILLO",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-378-5552",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G51357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Bui, DNP, APRN, ACNPC-BC
• Rachel Rebecca Buivids, M.S.P.T.
• Valerie May Nicol Bunker, M.S.
• Laura Nicole Burnside, BT
• Danielle Bustamante, BCBA
• Gerardo Bustillo, M.D.
• Eun Kwang Byun, MD
• C and a Health Services
• Dennis Anthony Cabrera, PHARMD
• Alberto Jose Cachero Jr.

• Specialist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.