Provider Demographics
NPI:1427616259
Name:SOUTHWEST PSYCHIATRY PLLC
Entity type:Organization
Organization Name:SOUTHWEST PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:915-244-4966
Mailing Address - Street 1:1209 WHIRL AWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7836
Mailing Address - Country:US
Mailing Address - Phone:915-244-4966
Mailing Address - Fax:
Practice Address - Street 1:5805 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-8001
Practice Address - Country:US
Practice Address - Phone:915-244-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140763OtherTEXAS LICENSE
NMAP55389OtherLICENSE NUMBER