Provider Demographics
NPI:1386693679
Name:BUSTILLO, PEDRO I (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:I
Last Name:BUSTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8334 SW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6973
Mailing Address - Country:US
Mailing Address - Phone:305-274-8583
Mailing Address - Fax:305-575-3226
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3180
Practice Address - Fax:305-575-3226
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL10,6212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology