Organization
BUSTILLO MEDICAL CORP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARDO BUSTILLO M.D. (PRESIDENT)
(714) 378-5552
Entity
Organization
Contact information
Practice address
9900 TALBERT AVE, SUITE 202, FOUNTAIN VALLEY, CA 92708-5153
(714) 378-5552
(714) 378-5541
Mailing address
9900 TALBERT AVE, SUITE 202, FOUNTAIN VALLEY, CA 92708-5153
(714) 378-5552
(714) 378-5541
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G51357
CA
Other
Enumeration date
05/03/2007
Last updated
05/08/2009
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