Healthcare Provider Details

I. General information

NPI: 1447516612
Provider Name (Legal Business Name): SAVANNA R BUSTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNA R REYES MD

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 GRANDE BLVD SE
RIO RANCHO NM
87124-1756
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8735
  • Fax: 505-272-8737
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0402
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: