=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699003855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAISA MERCEDES BASSART MSM, RD / LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2009
-----------------------------------------------------
Last Update Date | 11/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19590 OLD CUTLER RD JM PERDUE MEDICAL CENTER
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-8048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-466-3500
-----------------------------------------------------
Fax | 786-466-3889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8620 SW 196TH ST
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-8010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-255-0960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | ND3822
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------