Provider Demographics
NPI:1538959465
Name:BASSO, JULIETTE ALEXA
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:ALEXA
Last Name:BASSO
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 1:253 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4311
Mailing Address - Country:US
Mailing Address - Phone:646-676-2827
Mailing Address - Fax:
Practice Address - Street 1:240 SOUTH 40TH STREET OFFICE OF CLINICAL AFFAIRS-S6A EV
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-573-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program