Individual
DR. MAYRA S. BUSTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1115 WEBER ST, FRANKLIN, LA 70538-4124
(337) 828-2550
(337) 355-2335
Mailing address
1115 WEBER ST, FRANKLIN, LA 70538-4124
(337) 828-2550
(337) 355-2335
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
12129R
LA
2080P0214X
Pediatric Pulmonology Physician
L6308
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081278601
—
TX
05
—
1533467
—
LA
Enumeration date
05/15/2006
Last updated
06/17/2022
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