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General NPI Number Information
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NPI Number | 1275105942
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Entity Type | Individual
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Provider Name | DOMINGA BASURTO HEARONS NP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 9508 STOCKDALE HWY STE 150
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City | BAKERSFIELD
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State | CA
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Zip | 93311-3623
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Country | US
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Telephone | 661-663-7500
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Fax | 661-663-7503
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Provider Business Mailing Address
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Address Line | 24422 AVENIDA DE LA CARLOTA STE 300
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3628
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Country | US
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Telephone | 949-599-2434
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Fax | 949-599-2430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95017706
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 95017706
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License Number State | CA
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