Active NPI
Tatyana Basulto, PA-C
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1366200693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA64098
- Practice address
- 325 E 7TH St
Los Angeles, CA 90014-2209 - Phone
- (213) 893-1960
- NPI assigned
- Mar 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA64098 | CA | Primary |
Addresses
Primary practice location
325 E 7TH St
Los Angeles, CA 90014-2209
Mailing address
300 N Rampart St TRLR 139
Orange, CA 92868-1819
Phone (714) 675-1793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240612000195 | CA | Order and Referring Only - Physician Assistant | 5395287833 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA64098 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710115200000",
"number": "1366200693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N RAMPART ST TRLR 139",
"city": "ORANGE",
"state": "CA",
"postal_code": "928681819",
"telephone_number": "714-675-1793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E 7TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900142209",
"telephone_number": "213-893-1960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASULTO",
"first_name": "TATYANA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-11",
"last_updated": "2024-03-11",
"certification_date": "2024-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA64098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.