Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A20774 | CA |
NPI | 1487763611 |
---|---|
Provider Name | Dr. Lawrence Basso |
First Address | Menlo Park, CA 94025-3613 |
Second Address | Palo Alto, CA 94301-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 24/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A22324 | (02) | CA |