Provider Demographics
NPI:1780398156
Name:BUSTOS, ALEC HILARIO (RBT)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:HILARIO
Last Name:BUSTOS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 CONSTELLATION ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4700
Mailing Address - Country:US
Mailing Address - Phone:909-614-9277
Mailing Address - Fax:
Practice Address - Street 1:7661 CONSTELLATION ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4700
Practice Address - Country:US
Practice Address - Phone:909-614-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician