Provider Demographics
NPI:1346639770
Name:GUSTAMANTES, ANTHONY (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GUSTAMANTES
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 SIERRA NEVADA CIR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-573-8105
Mailing Address - Fax:
Practice Address - Street 1:701 UNSER BLVD SE STE 9
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6370
Practice Address - Country:US
Practice Address - Phone:505-892-7733
Practice Address - Fax:505-892-9341
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT4637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist