Provider Demographics
NPI:1598472409
Name:BASU, AJA (FNP)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:BASU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AJA
Other - Middle Name:SENNA
Other - Last Name:ESTARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7526
Mailing Address - Fax:
Practice Address - Street 1:5440 THORNWOOD DR STE G
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1217
Practice Address - Country:US
Practice Address - Phone:408-281-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily