MEDICARE: ELIAS ALEXIS BUSTILLOS

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	172V00000X	Community Health Worker		NM

General Provider Information

NPI Number	:	1437008935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS ALEXIS BUSTILLOS

Provider Business Mailing Address
First Line	:	2301 YALE BLVD SE STE F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 YALE BLVD SE STE F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4354
Country	:	US
Telephone Number	:	505-706-4891
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ ELIAS ALEXIS BUSTILLOS ” Practice Location

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