Healthcare Provider Details

I. General information

NPI: 1790692457
Provider Name (Legal Business Name): BELEN CAROLINA BUSTOS MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 E CANAL DR
TURLOCK CA
95380-4161
US

IV. Provider business mailing address

1700 N TULLY RD APT C222
TURLOCK CA
95380-2247
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-0632
  • Fax:
Mailing address:
  • Phone: 925-202-6413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: