Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Amanda Bustamante Provencio, MD

Individual provider Family Medicine Physician · NPI 1558855650

Dr. Amanda Bustamante Provencio, MD is a Family Practice in Las Cruces, New Mexico. Graduated from University of New Mexico School of Medicine in 2018, 8 years ago. Accepts Medicare assignment and offers telehealth. Licensed in New Mexico.

Years since qualifying
8
Trained at
University of New Mexico School of Medicine
Licensed in
NM
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1240 S Telshor Blvd Ste A
Las Cruces, NM 88011-4731
Phone: (575) 259-3638
Fax: (855) 538-0781
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence RS2018-0570 (NM)

Record details

NPI number1558855650
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 21, 2018
Last updated in NPPESAugust 25, 2025
Certification dateAugust 25, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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