Basic Information
| Provider Information | |||||||||
| NPI: | 1992917512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EUGENE J BASILIERE MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 MEDICAL CENTER CT | ||||||||
| Address2: | #209 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194278892 | ||||||||
| FaxNumber: | 6194227660 | ||||||||
| Practice Location | |||||||||
| Address1: | 765 MEDICAL CENTER CT | ||||||||
| Address2: | #209 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194278892 | ||||||||
| FaxNumber: | 6194227660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BASILIERE | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6194278892 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A42602 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00A426020 | 05 | CA | MEDICAID |