Provider Demographics
NPI:1548049760
Name:BASRA, AMITA (RN, AYURVEDA)
Entity type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:BASRA
Suffix:
Gender:F
Credentials:RN, AYURVEDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KEARNEY ST OFC F
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3520
Mailing Address - Country:US
Mailing Address - Phone:510-323-0015
Mailing Address - Fax:
Practice Address - Street 1:501 KEARNEY ST OFC F
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3520
Practice Address - Country:US
Practice Address - Phone:510-323-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836392163W00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse