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1720931512 NPI number — MR. MANUEL PERALTA BUSTOZ JR.

NPI Number: 1720931512
Health Care Provider/Practitioner: MR. MANUEL PERALTA BUSTOZ JR.

Information about “1720931512” NPI (MR. MANUEL PERALTA BUSTOZ JR.) exists in 1720931512 in HTML format HTML  |  1720931512 in plain Text format TXT  |  1720931512 in PDF (Portable Document Format) PDF  |  1720931512 in an XML format XML  formats.

NPI Number : 1720931512 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720931512",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUSTOZ",
    "FirstName": "MANUEL",
    "MiddleName": "PERALTA",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BUSTOZ",
    "OtherFirstName": "MANNY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4250 CLEAR CREEK ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT HOOD",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76544",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "254-213-3446",
    "MailingAddressFaxNumber": "254-213-1133",
    "FirstLinePracticeLocationAddress": "4250 CLEAR CREEK ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT HOOD",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76544",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "254-213-3446",
    "PracticeLocationAddressFaxNumber": "254-213-1133",
    "EnumerationDate": "02/19/2026",
    "LastUpdateDate": "02/19/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "MT145514",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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