Provider Demographics
NPI:1902074396
Name:BUSTAMANTE, JOHN V
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:BUSTAMANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-1327
Mailing Address - Country:US
Mailing Address - Phone:831-905-6604
Mailing Address - Fax:
Practice Address - Street 1:1131 SAN FELIPE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2800
Practice Address - Country:US
Practice Address - Phone:831-636-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)