Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101252920 | VA |
NPI | 1023096377 |
---|---|
Provider Name | Ana Cristina Basso |
First Address | Norfolk, VA 23505-4604 |
Second Address | Scott Depot, WV 25560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 16/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33575 | (02) |