Individual
MR. ROBERT LEONARD BUSUTTIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABC CO BOC BOCPO
Contact information
Practice address
367 ERVILLA ST, SUITE A, POMONA, CA 91767
(909) 629-7615
Mailing address
367 ERVILLA ST, SUITE A, POMONA, CA 91767
(909) 629-7615
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
C10438
MD
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
10/13/2006
Last updated
11/29/2007
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