1649588005 NPI number — MISS ANNA LIZA CELSO BASTON NURSE PRACTITIONER

Table of content: MISS ANNA LIZA CELSO BASTON NURSE PRACTITIONER (NPI 1649588005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649588005 NPI number — MISS ANNA LIZA CELSO BASTON NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASTON
Provider First Name:
ANNA LIZA
Provider Middle Name:
CELSO
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649588005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1465 E LEXINGTON
Provider Second Line Business Mailing Address:
UNIT 10-C
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-312-1003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1465 E LEXINGTON
Provider Second Line Business Practice Location Address:
UNIT 10-C
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-312-1003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  19760 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com