Provider Demographics
NPI:1770635716
Name:BARAJAS-BUSTOS, LIGIA PATRICIA (OT)
Entity type:Individual
Prefix:MRS
First Name:LIGIA
Middle Name:PATRICIA
Last Name:BARAJAS-BUSTOS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 S.W 19 PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991
Mailing Address - Country:US
Mailing Address - Phone:239-738-2918
Mailing Address - Fax:
Practice Address - Street 1:3820 COLONIAL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1094
Practice Address - Country:US
Practice Address - Phone:239-275-4411
Practice Address - Fax:239-275-6408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8236261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation