Healthcare Provider Details

I. General information

NPI: 1447463534
Provider Name (Legal Business Name): GINA BASUINO MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MERIDIAN AVE SUITE 150
SAN JOSE CA
95125-5350
US

IV. Provider business mailing address

938 CLARK AVE APT 18
MOUNTAIN VIEW CA
94040-2240
US

V. Phone/Fax

Practice location:
  • Phone: 408-979-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 30046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: