Basic Information
Provider Information
NPI: 1033557673
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASAGOITIA
FirstName: CAROLINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CADC INTERN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 205 S PRATT AVE
Address2:  
City: CARSON CITY
State: NV
PostalCode: 897014730
CountryCode: US
TelephoneNumber: 7758823945
FaxNumber: 7758826126
Practice Location
Address1: 205 S PRATT AVE
Address2:  
City: CARSON CITY
State: NV
PostalCode: 897014730
CountryCode: US
TelephoneNumber: 7758823945
FaxNumber: 7758826126
Other Information
ProviderEnumerationDate: 06/05/2013
LastUpdateDate: 06/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225400000X  N Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 
171M00000X01080-INTERNNVY Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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