Provider Demographics
NPI:1740539881
Name:BASLD
Entity type:Organization
Organization Name:BASLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:619-600-4392
Mailing Address - Street 1:713 BROADWAY
Mailing Address - Street 2:STE. E
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5313
Mailing Address - Country:US
Mailing Address - Phone:619-600-4392
Mailing Address - Fax:619-240-3780
Practice Address - Street 1:713 BROADWAY
Practice Address - Street 2:STE. E
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5313
Practice Address - Country:US
Practice Address - Phone:619-600-4392
Practice Address - Fax:619-240-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14252261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech