| NPI | 1982746673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA M BUSTOS Office Administration 979-830-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 525996) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2009-06-08 |