Individual
LESJUANTAVIUS NAJIIK BASKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
2826 INDIAN ST, FORT MYERS, FL 33916-2708
(239) 222-7203
Mailing address
2826 INDIAN ST, FORT MYERS, FL 33916-2708
(239) 222-7203
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
7654321
FL
183700000X
Pharmacy Technician
Primary
RPT29546
FL
251E00000X
Home Health Agency
RPT29546
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPT29546
HOME HEALTH
—
Enumeration date
10/30/2018
Last updated
10/30/2018
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