Provider Demographics
NPI:1285484402
Name:BUSTOS, MARIA VICTORIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:BUSTOS
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:YANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21601 E 32ND PL S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1163
Mailing Address - Country:US
Mailing Address - Phone:918-282-6141
Mailing Address - Fax:
Practice Address - Street 1:14002 E 21ST ST STE 650
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1432
Practice Address - Country:US
Practice Address - Phone:918-274-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OK6428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist