Individual
TEODORICO BASALLAJE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFA
Contact information
Practice address
5445 LA SIERRA DR, SUITE 410, DALLAS, TX 75231-4139
(214) 382-1909
(214) 382-1903
Mailing address
5445 LA SIERRA DR, SUITE 410, DALLAS, TX 75231-4139
(214) 382-1909
(214) 382-1903
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
7821
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7821
STATE OF TX
TX
Enumeration date
01/13/2010
Last updated
01/13/2010
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