Provider Demographics
NPI:1356101729
Name:BUSTILLO, EDUARDO JESUS (RMFTI, PMHNP)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JESUS
Last Name:BUSTILLO
Suffix:
Gender:M
Credentials:RMFTI, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W 35TH ST.
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5128
Mailing Address - Country:US
Mailing Address - Phone:305-527-0366
Mailing Address - Fax:305-224-0679
Practice Address - Street 1:12060 SW 129TH CT STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4582
Practice Address - Country:US
Practice Address - Phone:786-615-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4281106H00000X
FL9194886163W00000X
FLAPRN11041075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse