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General NPI Number Information
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NPI Number | 1336101880
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Entity Type | Organization
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Legal Business Name | HUMBERTO BASTO MD PA
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 21097 NE 27TH CT SUITE 210
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City | AVENTURA
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State | FL
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Zip | 33180-1204
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Country | US
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Telephone | 305-940-0068
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Fax | 305-932-3940
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Provider Business Mailing Address
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Address Line | 2300 NE 215 STREET
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-940-0068
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Fax | 305-932-3940
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUMBERTO BASTO
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Credential | MD PA
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Telephone | 305-940-0068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0036969
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License Number State | FL
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