Individual
ITZIA BASULTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
58457 TWENTYNINE PALMS HIGHWAY, SUITE 102A, YUCCA VALLEY, CA 92284
(760) 228-9657
(442) 205-0060
Mailing address
58457 TWENTYNINE PALMS HIGHWAY, SUITE 102A, YUCCA VALLEY, CA 92284
(760) 228-9657
(442) 205-0060
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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