Provider Demographics
NPI:1851989453
Name:OCHOA BASULTO, ANETT (MS)
Entity Type:Individual
Prefix:
First Name:ANETT
Middle Name:
Last Name:OCHOA BASULTO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10875 SW 112TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3223
Mailing Address - Country:US
Mailing Address - Phone:786-450-0848
Mailing Address - Fax:
Practice Address - Street 1:10875 SW 112TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3223
Practice Address - Country:US
Practice Address - Phone:786-450-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health