Organization
MARIO BUSTAMANTE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LETICIA A CANTU (BILLING MANAGER)
(210) 733-1802
Entity
Organization
Contact information
Practice address
12770 CIMARRON PATH, SUITE 132, SAN ANTONIO, TX 78249-3416
(210) 733-1802
(210) 733-1808
Mailing address
12770 CIMARRON PATH, SUITE 132, SAN ANTONIO, TX 78249-3416
(210) 733-1802
(210) 733-1808
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C14004
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076MN
BLUE CROSS GROUP
TX
05
—
168353401
—
TX
Enumeration date
06/13/2007
Last updated
01/05/2016
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