Individual provider · Type 1 NPI

Amanda Bustamante Provencio, MD

Family Medicine Physician · Las Cruces, NM

NPI number 1558855650 Active

Practice location

1240 S Telshor Blvd Ste A
Las Cruces, NM 88011-4731

Fax (855) 538-0781

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	RS2018-0570 (NM)

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

5 other providers at this address

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About NPI 1558855650

Amanda Bustamante Provencio, MD's National Provider Identifier is 1558855650, issued on Jun 21, 2018. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Las Cruces, NM. The record was last updated on Aug 25, 2025.