Individual
DR. ALFONSO BUSTAMANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1801 PARK COURT PL, SUITE E 102, SANTA ANA, CA 92701-5002
(714) 724-7412
Mailing address
1801 PARK COURT PL, SUITE E 102, SANTA ANA, CA 92701-5002
(714) 724-7412
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY17114
CA
Other
Enumeration date
10/03/2006
Last updated
03/11/2011
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