Provider Demographics
NPI:1427660281
Name:BUSTOS, DARLEEN RUBY
Entity type:Individual
Prefix:
First Name:DARLEEN
Middle Name:RUBY
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E TROPICANA AVE STE 199
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8323
Mailing Address - Country:US
Mailing Address - Phone:725-214-7776
Mailing Address - Fax:725-214-7768
Practice Address - Street 1:2523 CARROLL ST APT D
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5475
Practice Address - Country:US
Practice Address - Phone:702-300-6078
Practice Address - Fax:725-214-7768
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1606260402Medicaid