Individual
MRS. LETICIA A BASURTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5709 LEXINGTON DR, EL PASO, TX 79924-7410
(915) 751-4983
Mailing address
5709 LEXINGTON DR, EL PASO, TX 79924-7410
(915) 740-2687
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
148631
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000999813
STATE I.D.
TX
Enumeration date
02/16/2007
Last updated
04/25/2019
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