Provider Demographics
NPI:1336626381
Name:BASIL, ANASUYA (NC, DIPL ABT, CST)
Entity Type:Individual
Prefix:MS
First Name:ANASUYA
Middle Name:
Last Name:BASIL
Suffix:
Gender:F
Credentials:NC, DIPL ABT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:FOREST RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95942-0609
Mailing Address - Country:US
Mailing Address - Phone:510-848-8439
Mailing Address - Fax:
Practice Address - Street 1:10 WILLIAMSBURG LN STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2297
Practice Address - Country:US
Practice Address - Phone:510-848-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2467OtherAMERICAN ORGANIZATION OF BODYWORK THERAPIES OF ASIA MEMBER ID
24833OtherNATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE AND ORIENTAL MED, DIPL. ABT
CA20055OtherNATIONAL ASSOCIATION OF NUTRITION PROFESSIONALS PROF MEMBER ID
CA104192OtherCALIFORNIA MASSAGE THERAPY BOARD ID