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NPI Code Detail

MEDICARE: DR. EDUARDO JESUS BUSTILLO RMFTI, PMHNP

MEDICARE: DR. EDUARDO JESUS BUSTILLO RMFTI, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistIMT4281FL
2364SP0808XPsychiatric/Mental Health Clinical Nurse SpecialistAPRN11041075FL
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11041075FL
4163W00000XRegistered Nurse9194886FL

General Provider Information

NPI Number : 1356101729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDUARDO JESUS BUSTILLO RMFTI, PMHNP
Provider Business Mailing Address
First Line : 651 W 35TH ST.
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5128
Country : US
Telephone Number : 305-527-0366
Fax Number : 305-224-0679
Provider Business Practice Location Address
First Line : 12060 SW 129TH CT STE 201
Second Line :
City : MIAMI
State : FL
Zip : 33186-4582
Country : US
Telephone Number : 786-615-3349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2024
Last Update Date : 01/13/2026

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