Healthcare Provider Details

I. General information

NPI: 1457874893
Provider Name (Legal Business Name): RAMNEET BASRA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 FIELDSTONE DR STE 150
LINCOLN CA
95648-8808
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 916-909-3376
  • Fax: 916-884-9266
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: