Individual
DR. AMANDA BUSTAMANTE PROVENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1240 S TELSHOR BLVD STE A, LAS CRUCES, NM 88011-4731
(575) 259-3638
(855) 538-0781
Mailing address
1240 S TELSHOR BLVD STE A, LAS CRUCES, NM 88011-4731
(575) 259-3638
(855) 538-0781
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RS2018-0570
NM
Other
Enumeration date
06/21/2018
Last updated
08/25/2025
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