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LETICIA BUSTAMANTE
NPI 1609058924
Nurse Practitioner in Brawley, CA

Active since November 28, 2007PECOS EnrolledAccepts Medicare Assignment
751 WEST LEGION ROAD, SUITE 102, BRAWLEY, CA 92227(760) 351-8696(760) 545-0253 Get Directions Write a Review

NPPES record last updated: August 17, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 17, 2023, Oct 10, 2019, Sep 29, 2016 (3 updates tracked since 2016).

About Leticia Bustamante NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LETICIA BUSTAMANTE (NPI 1609058924) is an individual nurse practitioner in Brawley, California, licensed in California (FNP17877) and active in the NPI registry since November 2007. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2007).

NPPES Registry Identity

NPI1609058924
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameLETICIA BUSTAMANTE
Location Address751 WEST LEGION ROAD, SUITE 102Brawley, CA 92227
Mailing Address823 Gateway Center WaySan Diego, CA 92102-4541 · (619) 515-2300
Phone(760) 351-8696
Fax(760) 545-0253
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateNovember 28, 2007
Last NPPES UpdateAugust 17, 20233 updates tracked since enumeration
NPPES CertifiedAugust 17, 2023
✔ NPI 1609058924 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CA · FNP17877
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
751 WEST LEGION ROAD, Brawley, CA 92227
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Secondary Practice Locations 2

Location 11809 National AveSan Diego, CA 92113 · Phone (619) 515-2300
Location 22391 Island AveSan Diego, CA 92102 · Phone (619) 515-2435

Other Identifiers 2

MedicaidGR0066310CA
MedicaidFHC03830FCA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Leticia Bustamante is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6406134402
PECOS Enrollment IDI20161026001179
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Leticia Bustamante reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Imperial Valley Family Care Medical Group Apc
9.4 mi
General Practice
516 WEST ATEN ROAD, SUITE 2
Imperial, CA 92251
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Imperial Valley Family Care Medical Group A P C
  • 81 clinicians in this Medicare group
NPI 1275581894 (760) 355-7730
Family Health Centers Of San Diego, Inc
82 mi
Federally Qualified Health Center (FQHC)
1111 W CHASE AVE
El Cajon, CA 92020
  • Reassigned Medicare billing, California enrollment
  • 1,100 clinicians in this Medicare group
NPI 1104861681 (619) 515-2499

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92227 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.40 typical visit price
range $58.90 – $176.72
Typical copayment $22.60 (range $14.72 – $44.18)
Most-billed visit code 99203
Established Patient
$103.42 typical visit price
range $19.28 – $144.68
Typical copayment $25.85 (range $4.82 – $36.17)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers38 claims64 services$5.17 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers18 claims18 services$0.76 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Leticia Bustamante's NPI number?

The NPI number for Leticia Bustamante is 1609058924. It was assigned to this individual provider in the NPPES registry on November 28, 2007.

Where is Leticia Bustamante located?

Leticia Bustamante practices at 751 West Legion Road Suite 102, Brawley, CA 92227. The listed phone number is (760) 351-8696.

What is Leticia Bustamante's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Leticia Bustamante enrolled in Medicare?

Yes. Leticia Bustamante is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Leticia Bustamante's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Leticia Bustamante reassigns Medicare benefits to 2 organizations: Imperial Valley Family Care Medical Group Apc (Imperial, CA) and Family Health Centers Of San Diego, Inc (El Cajon, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Leticia Bustamante's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Leticia Bustamante was last updated on August 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.