Individual
IOSIF BASIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6330 SHELTER CREEK LN, SAN BRUNO, CA 94066-3872
(415) 672-7395
(415) 821-9883
Mailing address
6330 SHELTER CREEK LN, SAN BRUNO, CA 94066-3872
(415) 672-7395
(415) 821-9883
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
DL B6144499
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APPLICATION 488257
MEDI-CAL
CA
Enumeration date
12/12/2011
Last updated
09/17/2012
About Stedi
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