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1366200693
TATYANA BASULTO
LOS ANGELES, CA
NPI
1366200693
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CA PA64098)
Enumeration Date
2024-03-11
Last Update Date
2024-03-11
Business Address
TATYANA BASULTO PA-C
325 E 7TH ST
LOS ANGELES, CA 90014-2209
Phone number: 213-893-1960
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Mailing Address
TATYANA BASULTO PA-C
300 N RAMPART ST TRLR 139
ORANGE, CA 92868-1819
Phone number: 714-675-1793
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