Individual
ALEXIS BUSTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6200 S MOONEY BLVD, VISALIA, CA 93277-9396
(559) 747-3984
Mailing address
6200 S MOONEY BLVD, VISALIA, CA 93277-9396
(559) 747-3984
(818) 241-6853
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94-2191905
MEDICAL
CA
Enumeration date
12/10/2021
Last updated
03/08/2023
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