Individual
MINERVA SUSTAITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1845 TOMMY AARON DR, EL PASO, TX 79936
(915) 407-2359
Mailing address
1845 TOMMY AARON DR, EL PASO, TX 79936-4219
(915) 407-2359
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
311Z00000X
Custodial Care Facility
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
03/14/2017
Last updated
08/24/2018
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