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Organization
SOUTHWEST PSYCHIATRY PLLC
Active
Organization
SOUTHWEST PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL BUSTILLOS DNP (PMHNP)
(915) 244-4966
Entity
Organization
Contact information
Practice address
5805 MCNUTT RD, SANTA TERESA, NM 88008-8001
(915) 244-4966
Mailing address
1209 WHIRL AWAY DR, EL PASO, TX 79936-7836
(915) 244-4966
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP140763
TEXAS LICENSE
TX
01
—
AP55389
LICENSE NUMBER
NM
Enumeration date
06/05/2019
Last updated
06/05/2019
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