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General NPI Number Information
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NPI Number | 1134310642
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Entity Type | Organization
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Legal Business Name | TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 2251 W ELDORADO PKWY SUITE 100
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City | MCKINNEY
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State | TX
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Zip | 75070-4358
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Country | US
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Telephone | 972-562-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 2251 W ELDORADO PKWY SUITE 100
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City | MCKINNEY
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State | TX
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Zip | 75070-4358
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Country | US
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Telephone | 972-562-1188
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAYRA S. BUSTILLO
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Credential | MD
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Telephone | 972-562-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | L6308
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License Number State | TX
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