Most Relevant Information
Provider Data
| NPI Number: | 1003424961 |
| Provider Name: | JENNICA BUSTAMANTE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/16/2020 |
| Last Updated: | 07/16/2020 |
Provider Practice Location
880 E IDAHO AVE
LAS CRUCES
NM
880013746
Practice Location Phone/Fax
| Phone: | 5755561604 |
| Fax: |
Provider Mailing Location
1320 S SOLANO DR
LAS CRUCES
NM
880013758
Provider Mailing Phone/Fax
| Phone: | 5755224004 |
| Fax: |