Provider Demographics
NPI:1649588005
Name:BASTON, ANNA LIZA CELSO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:ANNA LIZA
Middle Name:CELSO
Last Name:BASTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1465 E LEXINGTON
Mailing Address - Street 2:UNIT 10-C
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019
Mailing Address - Country:US
Mailing Address - Phone:619-312-1003
Mailing Address - Fax:
Practice Address - Street 1:1465 E LEXINGTON
Practice Address - Street 2:UNIT 10-C
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019
Practice Address - Country:US
Practice Address - Phone:619-312-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner