Individual
SAMUEL CORREA BUSTILLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNP-AG
Contact information
Practice address
2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5141
(575) 636-7407
Mailing address
1455 S VALLEY DR STE A, LAS CRUCES, NM 88005-3165
(575) 526-7777
(575) 647-1125
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
CNP-03431
NM
Other
Enumeration date
11/20/2017
Last updated
08/21/2023
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