Organization
BASRI MD DIABETES RELIEF PC
Active
Parent organization
DIABETES RELIEF CENTER OF BRONX MSO LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIABETES RELIEF CENTER OF BRONX MSO LLC
Authorized official
DEANE WALLACE (CREDENTIALING SPECIALIST)
(916) 571-9041
Entity
Organization
Contact information
Practice address
2825 3RD AVE STE 200, BRONX, NY 10455-4066
(916) 550-1050
(916) 550-1238
Mailing address
4441 AUBURN BLVD STE J, SACRAMENTO, CA 95841-4139
(916) 550-1050
(916) 550-1238
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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