Provider Demographics
NPI:1447547393
Name:BASURTO, DESIREE A
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:BASURTO
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 1:1549 DEL NORTE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1108
Mailing Address - Country:US
Mailing Address - Phone:714-680-8265
Mailing Address - Fax:
Practice Address - Street 1:100 E VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1321
Practice Address - Country:US
Practice Address - Phone:714-680-8265
Practice Address - Fax:714-680-9007
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator