Healthcare Provider Details

I. General information

NPI: 1992851323
Provider Name (Legal Business Name): JEFFREY BASA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E WINNIE LN
CARSON CITY NV
89706-2268
US

IV. Provider business mailing address

5975 S LOS ALTOS PKWY
SPARKS NV
89436-7699
US

V. Phone/Fax

Practice location:
  • Phone: 775-204-4000
  • Fax: 775-234-4605
Mailing address:
  • Phone: 775-204-4000
  • Fax: 775-234-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8079
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number8079
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number8079
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: