Provider Demographics
NPI:1992338453
Name:BUSTOS, JOE R JR
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:R
Last Name:BUSTOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MCDOUGAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1422
Mailing Address - Country:US
Mailing Address - Phone:210-204-6451
Mailing Address - Fax:
Practice Address - Street 1:234 MCDOUGAL AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1422
Practice Address - Country:US
Practice Address - Phone:210-204-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis