Provider Demographics
NPI:1063010536
Name:BASULTO, VALERIE ANN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:BASULTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 M ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2714
Mailing Address - Country:US
Mailing Address - Phone:888-521-2695
Mailing Address - Fax:
Practice Address - Street 1:1118 M ST APT 213
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1075
Practice Address - Country:US
Practice Address - Phone:707-312-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty