Individual
DR. MAYRA S. BUSTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 PATTERSON ST, LAFAYETTE, LA 70501-1849
(337) 769-9451
(337) 769-9460
Mailing address
2000 OPELOUSAS ST, LAKE CHARLES, LA 70601-2641
(337) 439-9983
(337) 439-8898
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
06/10/2026
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