Provider Demographics
NPI:1811510951
Name:BASMAJIAN, KATARINA KAY
Entity type:Individual
Prefix:
First Name:KATARINA
Middle Name:KAY
Last Name:BASMAJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 A T AND T RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7241
Mailing Address - Country:US
Mailing Address - Phone:585-857-0555
Mailing Address - Fax:
Practice Address - Street 1:2551 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1213
Practice Address - Country:US
Practice Address - Phone:505-833-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator