Provider Demographics
NPI:1679694426
Name:DE ENCARNACION, BASILIA I (MD)
Entity type:Individual
Prefix:DR
First Name:BASILIA
Middle Name:I
Last Name:DE ENCARNACION
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:LL13 CALLE ROSE
Mailing Address - Street 2:ALTURAS DE BORINQUEN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5929
Mailing Address - Country:US
Mailing Address - Phone:787-640-3256
Mailing Address - Fax:787-731-5707
Practice Address - Street 1:AVE. ELEANOR ROOSEVELT 114 ALTOS 2DO. PISO
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-759-7035
Practice Address - Fax:787-753-8095
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5143OtherSTATE LICENSE