Individual
MRS. CHRISTINE BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
763 RIO RANCHO RD STE 120, POMONA, CA 91766-7015
(909) 243-7939
Mailing address
763 RIO RANCHO RD STE 120, POMONA, CA 91766-7015
(909) 243-7939
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
77989
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77989
—
CA
Enumeration date
01/15/2019
Last updated
01/15/2019
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