Individual
JENNICA BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
880 E IDAHO AVE, LAS CRUCES, NM 88001-3746
(575) 556-1604
Mailing address
1320 S SOLANO DR, LAS CRUCES, NM 88001-3758
(575) 522-4004
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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