Provider Demographics
NPI:1487334298
Name:NIX, BUSTER LEE
Entity type:Individual
Prefix:
First Name:BUSTER
Middle Name:LEE
Last Name:NIX
Suffix:
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 1:13191 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7306
Mailing Address - Country:US
Mailing Address - Phone:760-490-3248
Mailing Address - Fax:
Practice Address - Street 1:13191 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7306
Practice Address - Country:US
Practice Address - Phone:760-490-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)