Provider Demographics
NPI:1629542949
Name:LEONID BASOVICH DO INC
Entity type:Organization
Organization Name:LEONID BASOVICH DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:BASOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-884-2349
Mailing Address - Street 1:7777 GREENBACK LN STE 103
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5800
Mailing Address - Country:US
Mailing Address - Phone:916-905-1777
Mailing Address - Fax:888-855-7555
Practice Address - Street 1:7777 GREENBACK LN STE 103
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5800
Practice Address - Country:US
Practice Address - Phone:916-905-1777
Practice Address - Fax:888-855-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty