Provider Demographics
NPI:1750443123
Name:BUENTELLO, EFRAIN
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:BUENTELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 N REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3421
Mailing Address - Country:US
Mailing Address - Phone:361-664-0322
Mailing Address - Fax:
Practice Address - Street 1:1047 N REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3421
Practice Address - Country:US
Practice Address - Phone:361-664-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163WR0006X163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant