Individual
MR. GUSTAVO BUENTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 E NOLANA AVE, STE 17, MCALLEN, TX 78504-6104
(956) 630-1616
(956) 630-4733
Mailing address
PO BOX 3271, MCALLEN, TX 78502-3271
(956) 630-1616
(956) 630-4733
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
E1821
TX
208D00000X
General Practice Physician
Primary
E1821
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115280
CHIP
—
01
—
1332090-01
CSHCN
—
05
—
133209009
—
TX
01
—
8B4610
BCBS
—
Enumeration date
10/04/2006
Last updated
08/28/2019
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