Provider Demographics
NPI:1487941563
Name:DIGNA BASCO ESPEJO
Entity type:Organization
Organization Name:DIGNA BASCO ESPEJO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIGNA
Authorized Official - Middle Name:BASCO
Authorized Official - Last Name:ESPEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-741-7306
Mailing Address - Street 1:4175 LAKESIDE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5774
Mailing Address - Country:US
Mailing Address - Phone:510-741-8306
Mailing Address - Fax:510-724-1023
Practice Address - Street 1:4175 LAKESIDE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5774
Practice Address - Country:US
Practice Address - Phone:510-741-8306
Practice Address - Fax:510-724-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21650332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5566490002Medicare NSC