Provider Demographics
NPI:1861628505
Name:BASULTO BARCELAY, NORBE LUIS (LSA, FNP-C)
Entity Type:Individual
Prefix:
First Name:NORBE
Middle Name:LUIS
Last Name:BASULTO BARCELAY
Suffix:
Gender:M
Credentials:LSA, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29310 PRAIRIE ROSE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7384
Mailing Address - Country:US
Mailing Address - Phone:786-556-8819
Mailing Address - Fax:
Practice Address - Street 1:29310 PRAIRIE ROSE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7384
Practice Address - Country:US
Practice Address - Phone:786-556-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00474246ZC0007X, 246ZC0007X
TX1102060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861628505OtherUHC,BCBS,AETNA,CIGNA,WC
TX1861628505OtherUHC,AETNA,BCBS,CIGNA,WC
TX1861628505OtherCOMMUNITY HEALTH CHOICE
TX1861628505OtherDEVOTED HEALTH
TX1861628505Medicaid
1861628505OtherHUMANA
1861628505OtherCOMMUNITY HEALTH CHOICE