Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME91869 | FL |
Y | 207YS0123X | Facial Plastic Surgeon | ME91869 | FL |
NPI | 1275527749 |
---|---|
Provider Name | Andres Bustillo Lopez |
First Address | South Miami, FL 33143-3622 |
Second Address | South Miami, FL 33143-3622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275991800 | (05) | FL |
I36934 | (02) | FL |