Provider Demographics
NPI:1215243753
Name:PEREZ BUSTAMANTE, MARCELA (MD)
Entity type:Individual
Prefix:MS
First Name:MARCELA
Middle Name:
Last Name:PEREZ BUSTAMANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N FLAGLER DR STE 430
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3430
Mailing Address - Country:US
Mailing Address - Phone:561-659-6336
Mailing Address - Fax:561-659-2150
Practice Address - Street 1:1515 N FLAGLER DR STE 430
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3430
Practice Address - Country:US
Practice Address - Phone:561-659-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117087207RE0101X
FLTRN15132390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program