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NPI Code Detail

MEDICARE: EDUARDO GABRIEL BUSTOS GOMEZ

MEDICARE: EDUARDO GABRIEL BUSTOS GOMEZ
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 : 1962366526
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDUARDO GABRIEL BUSTOS GOMEZ
Provider Business Mailing Address
First Line : 19318 JESSE LN
Second Line :
City : RIVERSIDE
State : CA
Zip : 92508-5090
Country : US
Telephone Number : 951-900-7411
Fax Number :
Provider Business Practice Location Address
First Line : 19318 JESSE LN
Second Line :
City : RIVERSIDE
State : CA
Zip : 92508-5090
Country : US
Telephone Number : 951-900-7411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ EDUARDO GABRIEL BUSTOS GOMEZ ” Practice Location

Language Start Address Practice Location
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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