MEDICARE: BASMALA JAMAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		FL
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1174478457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASMALA JAMAL

Provider Business Mailing Address
First Line	:	AVENIDA JOSE GAUTIER BENITEZ
Second Line	:	NUMERO 230 BO
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVENIDA JOSE GAUTIER BENITEZ
Second Line	:	NUMERO 230 BO. PUEBLO
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	813-396-0075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	06/02/2026

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