MEDICARE: DARLEEN RUBY BUSTOS

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
1	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427660281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLEEN RUBY BUSTOS

Provider Business Mailing Address
First Line	:	1516 E TROPICANA AVE STE 199
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8323
Country	:	US
Telephone Number	:	725-214-7776
Fax Number	:	725-214-7768

Provider Business Practice Location Address
First Line	:	2523 CARROLL ST APT D
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5475
Country	:	US
Telephone Number	:	702-300-6078
Fax Number	:	725-214-7768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/26/2020

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Directions to “ DARLEEN RUBY BUSTOS ” Practice Location

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