Individual
LETICIA BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
751 WEST LEGION ROAD, SUITE 102, BRAWLEY, CA 92227
(760) 351-8696
(760) 545-0253
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
FNP17877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC03830F
—
CA
05
—
GR0066310
—
CA
Enumeration date
11/28/2007
Last updated
08/17/2023
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