Doctor Name: | MR. LAURO JOSEPH BUSTAMANTE |
NPI Number: | 1053430736 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | T-0099671 |
Business Practice Address: | 6621 Doniphan Canutillo, TX - 79835 |
Business Phone Number: | 5758825100 |
Business Fax Number: | 5758821157 |
Mailing Address: | 6621 Doniphan Dr Ste G, CANUTILLO |
State: | TX |
Postal Code: | 798355005 |
Phone Number: | 9158775100 |
Fax Number: | 9158775107 |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 04/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | T-0099671 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |