Provider Demographics
NPI:1619756400
Name:LABASAN, KAYE AQUINDE (NP)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:AQUINDE
Last Name:LABASAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 SONATA DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3874
Mailing Address - Country:US
Mailing Address - Phone:707-863-1000
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 301
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3931
Practice Address - Country:US
Practice Address - Phone:650-342-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily