Individual
BASANTA KC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12750 CENTER COURT DR S STE 650, CERRITOS, CA 90703-8569
(323) 628-8671
Mailing address
16143 WOODBRIER DR, WHITTIER, CA 90604-3764
(626) 893-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
088676-23
NH
363LF0000X
Family Nurse Practitioner
11286
CT
363LF0000X
Family Nurse Practitioner
Primary
95006273
CA
363LF0000X
Family Nurse Practitioner
APRN03136
RI
Other
Enumeration date
10/26/2017
Last updated
04/19/2023
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