Individual
ELLEN BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
255 E BONITA AVE, POMONA, CA 91767-1923
(909) 596-7733
Mailing address
6131 ANDOVER WOOD RD, LAS VEGAS, NV 89113-1882
(714) 928-4009
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
22155
CA
235Z00000X
Speech-Language Pathologist
Primary
2254
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22155
SLP STATE LICENSE
CA
Enumeration date
05/25/2017
Last updated
11/08/2019
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