Provider Demographics
NPI:1437395746
Name:BUSTILLOS, EVE
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:BUSTILLOS
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 1:11997 GREENVEIL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0386
Mailing Address - Country:US
Mailing Address - Phone:915-252-7829
Mailing Address - Fax:
Practice Address - Street 1:11997 GREENVEIL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0386
Practice Address - Country:US
Practice Address - Phone:915-252-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA084746313747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider