Provider Demographics
NPI:1114698941
Name:BUSTO, KAYLIN LAZARA
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:LAZARA
Last Name:BUSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11471 SW 248TH LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4729
Mailing Address - Country:US
Mailing Address - Phone:305-744-1594
Mailing Address - Fax:
Practice Address - Street 1:11471 SW 248TH LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4729
Practice Address - Country:US
Practice Address - Phone:305-744-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician