Provider Demographics
NPI:1699003855
Name:BASSART, RAISA MERCEDES (MSM, RD / LD)
Entity Type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:MERCEDES
Last Name:BASSART
Suffix:
Gender:F
Credentials:MSM, RD / LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 SW 196TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8010
Mailing Address - Country:US
Mailing Address - Phone:305-255-0960
Mailing Address - Fax:
Practice Address - Street 1:19590 OLD CUTLER RD
Practice Address - Street 2:JM PERDUE MEDICAL CENTER
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8048
Practice Address - Country:US
Practice Address - Phone:786-466-3500
Practice Address - Fax:786-466-3889
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered