Provider Demographics
NPI:1598652299
Name:BASART, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:BASART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 NW 6TH LN APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3846
Mailing Address - Country:US
Mailing Address - Phone:786-805-2648
Mailing Address - Fax:
Practice Address - Street 1:8695 NW 6TH LN APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3846
Practice Address - Country:US
Practice Address - Phone:786-805-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1334929106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician