Active NPI
Ana Luisa Bustamante, PH.D.
- Psychologist
- Goodyear, AZ
National Provider Identifier
1679693709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1037
- Practice address
- 17550 W Desert Sage Dr
Goodyear, AZ 85338-5756 - Phone
- (602) 418-2049
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1037 | AZ | Primary |
Addresses
Primary practice location
17550 W Desert Sage Dr
Goodyear, AZ 85338-5756
Mailing address
17550 W Desert Sage Dr
Goodyear, AZ 85338-5756
Phone (602) 418-2049
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1037 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185235200000",
"number": "1679693709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17550 W DESERT SAGE DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853385756",
"telephone_number": "602-418-2049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17550 W DESERT SAGE DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853385756",
"telephone_number": "602-418-2049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSTAMANTE",
"first_name": "ANA",
"middle_name": "LUISA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "1037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.