Provider Demographics
NPI:1508951682
Name:BUENTELLO, GUSTAVO (MD)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:BUENTELLO
Suffix:
Gender:M
Credentials:MD
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:956-630-4733
Practice Address - Street 1:801 E NOLANA AVE
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:956-630-4733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1821208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
115280OtherCHIP
TX133209009Medicaid
1332090-01OtherCSHCN
8B4610OtherBCBS
C13913Medicare UPIN
TXTXB106582Medicare PIN