Healthcare Provider Details

I. General information

NPI: 1023487766
Provider Name (Legal Business Name): VINEETA BASUTKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VINEETA RANI

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95001544
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberNP95001544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: