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General NPI Number Information
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NPI Number | 1457589699
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Entity Type | Individual
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Provider Name | AMAYA MARIE BASTA MD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-6241
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Country | US
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Telephone | 866-320-4573
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Fax |
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Provider Business Mailing Address
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Address Line | 64 HOMESTEAD DR
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City | BOISE
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State | ID
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Zip | 83716-3018
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Country | US
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Telephone | 206-484-0907
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 340687
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 115078
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M13201
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License Number State | ID
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