Provider Demographics
NPI:1043711484
Name:MONTES, FAUSTO (BSN, RN)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:
Last Name:MONTES
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 GROVER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4009
Mailing Address - Country:US
Mailing Address - Phone:806-241-1266
Mailing Address - Fax:
Practice Address - Street 1:810 GROVER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4009
Practice Address - Country:US
Practice Address - Phone:806-241-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735989163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse