Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME137233 | FL |
NPI | 1164743837 |
---|---|
Provider Name | Rafael Miguel Bustamante |
First Address | Fort Lauderdale, FL 33309-3750 |
Second Address | Fort Lauderdale, FL 33316-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 09/08/2019 |