Individual
EUGENE JOSEPH BASILIERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A42602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A426020
—
CA
Enumeration date
04/03/2006
Last updated
12/20/2013
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