Healthcare Provider Details

I. General information

NPI: 1801831409
Provider Name (Legal Business Name): VICTORIA BASKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 W OAKLAND PARK BLVD
WILTON MANORS FL
33311-1731
US

IV. Provider business mailing address

919 NE 13TH ST
FORT LAUDERDALE FL
33304-2009
US

V. Phone/Fax

Practice location:
  • Phone: 954-567-7141
  • Fax: 954-565-5624
Mailing address:
  • Phone: 954-763-2030
  • Fax: 954-763-9847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number124909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: