Individual provider · NPI-1

Sam Basta

Technician, Attendant Care Provider · Los Angeles, CA

NPI number1174092506
StatusActive
Last updated in NPPESNov 14, 2018

Details

NPI
1174092506
Entity type
Individual (NPI-1)
Name
Sam Basta
Sex
Male
Sole proprietor
No
Enumeration date
Nov 14, 2018
Last updated
Nov 14, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3747A0650X Technician, Attendant Care Provider––Yes

Practice location

3757 Kelton Ave Apt 211
Los Angeles, CA 90034-7135

Phone 310-465-6019

Mailing address

3757 Kelton Ave Apt 211
Los Angeles, CA 90034-7135

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