Provider Demographics
NPI:1689183006
Name:BASI, MANJIT KAUR
Entity Type:Individual
Prefix:
First Name:MANJIT
Middle Name:KAUR
Last Name:BASI
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 1:20829 ANZA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4219
Mailing Address - Country:US
Mailing Address - Phone:424-488-4639
Mailing Address - Fax:
Practice Address - Street 1:20300 S VERMONT AVE STE 245
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1355
Practice Address - Country:US
Practice Address - Phone:310-787-1335
Practice Address - Fax:310-787-1809
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12268-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)