Manuel Anthony Bustamante, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

29218 Issued in CA

Practice address

11645 Wilshire Blvd
Suite 1160
Los Angeles, CA 90025-6811

Phone

(310) 473-5559

NPI assigned

Jul 27, 2010

Last updated

Jul 27, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Bustamante Endodontics Adc

  • Endodontics
  • Los Angeles, CA
  • NPI 1710074513
  NPD (past) Authorized official

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1912211426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 1160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256811",
            "telephone_number": "310-473-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD",
            "address_2": "SUITE 1160",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256811",
            "telephone_number": "310-473-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "MANUEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-27",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "29218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela Steeg Bustamante, PMHNP
• Danny Depalobos Bustamante
• Denise Shaila Bustamante
• Gemilee Bustamante, PHARMD
• Jose Juan Bustamante, BCBA
• Martha Priscilla Bustamante
• Odeth Bustamante
• Pamela Bustamante
• Priscilla Soliman Bustamante, D.D.S.
• Susana Rabena Bustamante, LCSW

• Endodontics in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.