Myra Bustamante

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN682197 Issued in CA

Practice address

12755 N Highway 88
Lodi, CA 95240-9323

Phone

(209) 340-5800

Fax

(209) 340-5804

NPI assigned

Jun 9, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Victor Treatment Centers, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Lodi, CA
  • NPI 1861551715
  NPD (past)

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461110400000",
    "number": "1730474529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12755 N HIGHWAY 88",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952409323",
            "telephone_number": "209-340-5800",
            "fax_number": "209-340-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12755 N HIGHWAY 88",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952409323",
            "telephone_number": "209-340-5800",
            "fax_number": "209-340-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "MYRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-09",
        "last_updated": "2016-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "LP034207",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN682197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tedra L Burke-Searls, D.C.
• Germaine Noel Burke, O.D.
• Jerome A Burke, O.D.
• Debbie Ann Burns, PHARM D.
• Arianna Bush
• Cadri Transport LLC
• Cahill Medical Inc
• Cahill Medical Inc
• Cali Express Medicab
• California Em-I Medical Services

• Licensed Vocational Nurse in Lodi, CA
• Providers in Lodi, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.