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General NPI Number Information
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NPI Number | 1740004894
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Entity Type | Organization
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Legal Business Name | JBASULTO HEALTH CARE LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 20051 NW 77TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-6419
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Country | US
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Telephone | 786-797-7134
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Fax |
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Provider Business Mailing Address
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Address Line | 20051 NW 77TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-6419
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Country | US
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Telephone | 786-797-7134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANISSET BASULTO
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Credential | APRN-FNP
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Telephone | 786-797-7134
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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 |
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License Number State |
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