Provider Demographics
NPI:1114380003
Name:BASIL R. BESH, M.D., INC
Entity type:Organization
Organization Name:BASIL R. BESH, M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIRRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-857-1000
Mailing Address - Street 1:39180 FARWELL DR STE 231
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1015
Mailing Address - Country:US
Mailing Address - Phone:510-585-2545
Mailing Address - Fax:
Practice Address - Street 1:39180 FARWELL DR STE 231
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1015
Practice Address - Country:US
Practice Address - Phone:510-585-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASIL R. BESH, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83582261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty