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NPI Code Detail

MEDICARE: HORTENCIA LUISA BUSTILLO

MEDICARE:   HORTENCIA LUISA BUSTILLO
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
1363LF0000XFamily Nurse Practitioner11008552FL

Other Identifiers

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

General Provider Information

NPI Number : 1508470006
Entity Type Code : Individual
Provider Name (Legal Business Name) : HORTENCIA LUISA BUSTILLO
Provider Business Mailing Address
First Line : 6825 SW 18TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33155-1723
Country : US
Telephone Number : 786-879-3071
Fax Number :
Provider Business Practice Location Address
First Line : 6825 SW 18TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33155-1723
Country : US
Telephone Number : 786-879-3071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 09/02/2020

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Directions to “ HORTENCIA LUISA BUSTILLO ” Practice Location

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