Healthcare Provider Details

I. General information

NPI: 1710831482
Provider Name (Legal Business Name): ARIANA JAILYN MARIE BUSTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1114 FAIRGROUNDS RD
SOCORRO NM
87801-4054
US

IV. Provider business mailing address

1114 FAIRGROUNDS RD
SOCORRO NM
87801-4054
US

V. Phone/Fax

Practice location:
  • Phone: 505-514-8128
  • Fax:
Mailing address:
  • Phone: 505-514-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: