Provider Demographics
NPI:1053666297
Name:MICHELENA BASANTES, VANESSA M (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:MICHELENA BASANTES
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4904 TAHAN WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0428
Mailing Address - Country:US
Mailing Address - Phone:909-561-5032
Mailing Address - Fax:
Practice Address - Street 1:4904 TAHAN WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0428
Practice Address - Country:US
Practice Address - Phone:909-561-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2014-06-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant