Provider Demographics
NPI:1083738231
Name:BUENTELLO, LUIS D (DC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:D
Last Name:BUENTELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3271
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3271
Mailing Address - Country:US
Mailing Address - Phone:956-630-1616
Mailing Address - Fax:
Practice Address - Street 1:801 E NOLANA ST
Practice Address - Street 2:STE. #17
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6104
Practice Address - Country:US
Practice Address - Phone:956-630-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7934111N00000X
TX792698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX292254YSS2Medicare PIN
TXTXB106722Medicare PIN