Healthcare Provider Details

I. General information

NPI: 1427727908
Provider Name (Legal Business Name): JENNIFER KARINA BASULTO MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 WHITTIER BLVD
WHITTIER CA
90605-2130
US

IV. Provider business mailing address

1041 GILWOOD AVE
LA PUENTE CA
91744-2122
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-5900
  • Fax:
Mailing address:
  • Phone: 626-465-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number108825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: