Healthcare Provider Details

I. General information

NPI: 1154836153
Provider Name (Legal Business Name): MARK E BASIRATMAND N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26357 MCBEAN PKWY SUITE 320
VALENCIA CA
91355-4488
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-888-2600
  • Fax: 661-222-2660
Mailing address:
  • Phone: 818-837-5559
  • Fax: 818-792-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: