Healthcare Provider Details

I. General information

NPI: 1174478457
Provider Name (Legal Business Name): BASMALA JAMAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA JOSE GAUTIER BENITEZ NUMERO 230 BO. PUEBLO
CAGUAS PR
00725
US

IV. Provider business mailing address

AVENIDA JOSE GAUTIER BENITEZ NUMERO 230 BO
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 813-396-0075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: