Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME0023474 | FL |
NPI | 1205954336 |
---|---|
Provider Name | Rafael Pedro Busto |
First Address | Boca Raton, FL 33486-2359 |
Second Address | Boca Raton, FL 33486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71774 | BCBS (01) | FL |
D26939 | (02) |