Mario Bustamante MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

C14004 Issued in TX

Legal business name

MARIO BUSTAMANTE MD PA

Practice address

12770 Cimarron Path
Suite 132
San Antonio, TX 78249-3416

Phone

(210) 733-1802

Fax

(210) 733-1808

NPI assigned

Jun 13, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Leticia A Cantu

Title

Billing Manager

Phone

(210) 733-1802

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mario A Bustamante, MD

  • Orthopaedic Surgery Physician
  • San Antonio, TX
  • NPI 1972546109
  Medicare reassignment NPD
• Steven Jeffrey Cyr, MD

  • Orthopaedic Surgery of the Spine Physician
  • San Antonio, TX
  • NPI 1942289970
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1477757334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12770 CIMARRON PATH",
            "address_2": "SUITE 132",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782493416",
            "telephone_number": "210-733-1802",
            "fax_number": "210-733-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12770 CIMARRON PATH",
            "address_2": "SUITE 132",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782493416",
            "telephone_number": "210-733-1802",
            "fax_number": "210-733-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO BUSTAMANTE MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "CANTU",
        "authorized_official_first_name": "LETICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "210-733-1802",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "C14004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168353401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "0076MN",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Marin, PA-C
• Valeria Marin, DNP, APRN FNP-BC
• Yolanda Marin, LMSW
• Roxane C Marines, LPC
• Myrna Gaxiola Marinik, LCSW
• Davorian Treyvon Marion, LPC
• Marios Pharmacy Inc
• Rebecca R Maris, LVN
• Barbara G Mariscal, RN, PNP
• Desiree Mariscal

• Specialist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.