Healthcare Provider Details

I. General information

NPI: 1669389128
Provider Name (Legal Business Name): ALEJANDRO BUSTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W. AVENUE NILE BUILDING
YAKIMA WA
98902-9856
US

IV. Provider business mailing address

PO BOX 10205
YAKIMA WA
98909-1205
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-2885
  • Fax:
Mailing address:
  • Phone: 509-426-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberWDL25541J63B
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: