Individual
REX BUSTAMAMNTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
4704233790
MI
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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