Provider Demographics
NPI:1144002338
Name:ALVAREZ, MONSIEUR DEO BUSTILLO (MLS ASCPI)
Entity type:Individual
Prefix:
First Name:MONSIEUR DEO
Middle Name:BUSTILLO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MLS ASCPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 LEGACY WAY
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-8923
Mailing Address - Country:US
Mailing Address - Phone:682-812-0290
Mailing Address - Fax:
Practice Address - Street 1:1614 LEGACY WAY
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326-8923
Practice Address - Country:US
Practice Address - Phone:682-812-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory