Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A13731 | CA |
Y | 207Q00000X | Family Doctor | A13731 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A13731 | CA |
NPI | 1285626515 |
---|---|
Provider Name | Dr. Leonid Basovich |
First Address | Citrus Heights, CA 95610-5800 |
Second Address | Citrus Heights, CA 95610-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 13/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I36307 | (02) | NY |