Provider Demographics
NPI:1518560820
Name:BASICAL, JANIS
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:BASICAL
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 1:1435 N HARBOR BLVD # 124
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4105
Mailing Address - Country:US
Mailing Address - Phone:714-773-0077
Mailing Address - Fax:714-773-0067
Practice Address - Street 1:1600 N ACACIA AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1207
Practice Address - Country:US
Practice Address - Phone:714-773-0077
Practice Address - Fax:714-773-0067
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician