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General NPI Number Information
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NPI Number | 1366954620
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Entity Type | Individual
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Provider Name | BASANTA KC NP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 12750 CENTER COURT DR S STE 650
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City | CERRITOS
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State | CA
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Zip | 90703-8569
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Country | US
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Telephone | 323-628-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 16143 WOODBRIER DR
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City | WHITTIER
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State | CA
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Zip | 90604-3764
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Country | US
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Telephone | 626-893-3700
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Fax |
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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 | 11286
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006273
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 088676-23
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN03136
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License Number State | RI
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