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General NPI Number Information
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NPI Number | 1497089031
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Entity Type | Organization
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Legal Business Name | GUSTAVO BUENTELLO MD F. A. A. P., PA
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 801 E NOLANA AVE SUITE 17
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City | MCALLEN
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State | TX
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Zip | 78504-6104
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Country | US
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Telephone | 956-630-1616
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Fax | 956-630-4733
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Provider Business Mailing Address
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Address Line | 801 E NOLANA AVE SUITE 17
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City | MCALLEN
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State | TX
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Zip | 78504-6104
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Country | US
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Telephone | 956-630-1616
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Fax | 956-630-4733
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LUIS BUENTELLO
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Credential | DC
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Telephone | 956-630-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E1821
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License Number State | TX
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