Provider Demographics
NPI:1497089031
Name:GUSTAVO BUENTELLO MD F. A. A. P., PA
Entity Type:Organization
Organization Name:GUSTAVO BUENTELLO MD F. A. A. P., PA
Other - Org Name:BUENTELLO MEDICAL AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-630-1616
Mailing Address - Street 1:801 E NOLANA AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6104
Mailing Address - Country:US
Mailing Address - Phone:956-630-1616
Mailing Address - Fax:956-630-4733
Practice Address - Street 1:801 E NOLANA AVE
Practice Address - Street 2:SUITE 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:956-630-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1821208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13913Medicare UPIN