Healthcare Provider Details

I. General information

NPI: 1881396133
Provider Name (Legal Business Name): CAMILLE BASURTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

IV. Provider business mailing address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 540-336-8524
  • Fax:
Mailing address:
  • Phone: 540-336-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102209758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: