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NPI Code Detail

MEDICARE: KIRALAYNE NICOLE BUSTAMANTE

MEDICARE: KIRALAYNE NICOLE BUSTAMANTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1114884939
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRALAYNE NICOLE BUSTAMANTE
Provider Business Mailing Address
First Line : 3625 CITADEL DR S
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-5320
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 304 E ROUTT AVE
Second Line :
City : PUEBLO
State : CO
Zip : 81004-2122
Country : US
Telephone Number : 719-357-4066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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Directions to “ KIRALAYNE NICOLE BUSTAMANTE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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