# MR. GUSTAVO BUENTELLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1508951682
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | E1821 | TX | — |
| 208D00000X | General Practice Physician | E1821 | TX | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/28/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 115280 | CHIP | — |
| 01 | — | 1332090-01 | CSHCN | — |
| 05 | — | 133209009 | — | TX |
| 01 | — | 8B4610 | BCBS | — |