Individual
SAM BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3757 KELTON AVE APT 211, LOS ANGELES, CA 90034-7135
(310) 465-6019
Mailing address
3757 KELTON AVE APT 211, LOS ANGELES, CA 90034-7135
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473411858
—
CA
Enumeration date
11/14/2018
Last updated
11/14/2018
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