Provider Demographics
NPI:1316308257
Name:BASTA, LAILA LOFTY (MD)
Entity type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:LOFTY
Last Name:BASTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAILA
Other - Middle Name:L
Other - Last Name:BASTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:765 MARKET STREET
Mailing Address - Street 2:APARTMENT 35A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2041
Mailing Address - Country:US
Mailing Address - Phone:415-896-5835
Mailing Address - Fax:415-896-5836
Practice Address - Street 1:765 MARKET STREET
Practice Address - Street 2:APARTMENT 35A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2041
Practice Address - Country:US
Practice Address - Phone:415-896-5835
Practice Address - Fax:415-896-5836
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology