Individual
KARLA BASULTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
316 FREDERICK DR, GEORGETOWN, TX 78626-2619
(512) 649-6125
Mailing address
316 FREDERICK DR, GEORGETOWN, TX 78626-2619
(512) 649-6125
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
23-430
TX
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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