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General NPI Number Information
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NPI Number | 1356101729
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Entity Type | Individual
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Provider Name | EDUARDO JESUS BUSTILLO RMFTI, PMHNP
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Gender | Male
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 12060 SW 129TH CT STE 201
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City | MIAMI
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State | FL
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Zip | 33186-4582
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Country | US
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Telephone | 786-615-3349
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Fax |
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Provider Business Mailing Address
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Address Line | 651 W 35TH ST.
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City | HIALEAH
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State | FL
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Zip | 33012-5128
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Country | US
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Telephone | 305-527-0366
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Fax | 305-224-0679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT4281
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9194886
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11041075
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License Number State | FL
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