Individual
BENJAMIN LOGAN BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
928 BROADWAY, SAN DIEGO, CA 92101-5514
(619) 977-3716
(619) 481-3075
Mailing address
928 BROADWAY, SAN DIEGO, CA 92101-5514
(619) 977-3716
(619) 481-3075
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
CA
Other
Enumeration date
07/13/2023
Last updated
06/28/2024
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