Healthcare Provider Details

I. General information

NPI: 1447194014
Provider Name (Legal Business Name): JENNIFER BASURTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S WHITE RD
SAN JOSE CA
95127-4760
US

IV. Provider business mailing address

450 HARVARD AVE APT 1P
SANTA CLARA CA
95051-6441
US

V. Phone/Fax

Practice location:
  • Phone: 408-673-4892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: