Individual
DR. JERROLD C BUSTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 S. CITRUS AVENUE, SUITE #201, AZUSA, CA 91702
(626) 974-1441
Mailing address
394 S LOS ROBLES AVE APT 2, PASADENA, CA 91101-3298
(626) 584-6370
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A85842
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
A85842
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A85842
CA, MEDICAL LICENSE
CA
Enumeration date
05/12/2006
Last updated
07/03/2012
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