Healthcare Provider Details

I. General information

NPI: 1356101729
Provider Name (Legal Business Name): EDUARDO JESUS BUSTILLO RMFTI, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SW 117TH AVE STE C205
MIAMI FL
33186-2185
US

IV. Provider business mailing address

8900 SW 117TH AVE STE C205
MIAMI FL
33186-2185
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-8600
  • Fax: 954-248-1973
Mailing address:
  • Phone: 305-640-8600
  • Fax: 954-248-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9194886
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11041075
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11041075
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: