1346468188 NPI number — DOCTORS REFFINO PEREYRA AND BASILICO FAMILY PRACTICE, PA

Table of content: (NPI 1346468188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346468188 NPI number — DOCTORS REFFINO PEREYRA AND BASILICO FAMILY PRACTICE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS REFFINO PEREYRA AND BASILICO FAMILY PRACTICE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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NPI Number Information

NPI Number:
1346468188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7522 CAMPBELL ROAD
Provider Second Line Business Mailing Address:
SUITE100
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75248-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-267-6653
Provider Business Mailing Address Fax Number:
972-248-3604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7522 CAMPBELL ROAD
Provider Second Line Business Practice Location Address:
SUITE100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75248-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-267-6653
Provider Business Practice Location Address Fax Number:
972-248-3604
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BASILICO
Authorized Official First Name:
LEOPOLDO
Authorized Official Middle Name:
MARIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-267-6653

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  K6534 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 092507501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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