Anthony Bustos, CONTRACTS/CORRECTION
Individual provider Active NPI Counselor · Clovis, NM
NPI 1124351192 · NPPES record last updated Sep 9, 2009
Key facts
- NPI
- 1124351192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 121 Townsgate
Clovis, NM 88101 - Phone
- (575) 742-2620
- Fax
- (575) 742-3182
- NPI assigned
- Sep 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
121 Townsgate
Clovis, NM 88101
Mailing address
PO Box 28220
Santa Fe, NM 87592
Phone (505) 471-5006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L7094 | Medicaid | NM |
Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.