Provider Demographics
NPI:1154836153
Name:BASIRATMAND, MARK E (NP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BASIRATMAND
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:26357 MCBEAN PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4488
Practice Address - Country:US
Practice Address - Phone:661-888-2600
Practice Address - Fax:661-222-2660
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2019-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95008086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily