MEDICARE: DR. LEONID BASOVICH DO, DAOBFP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	A13731	CA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A13731	CA
3	207Q00000X	Family Medicine Physician	A13731	CA

General Provider Information

NPI Number	:	1285626515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONID BASOVICH DO, DAOBFP

Provider Business Mailing Address
First Line	:	7777 GREENBACK LN STE 103
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5800
Country	:	US
Telephone Number	:	916-905-1777
Fax Number	:	888-855-7555

Provider Business Practice Location Address
First Line	:	7777 GREENBACK LN STE 103
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5800
Country	:	US
Telephone Number	:	916-905-1777
Fax Number	:	888-855-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	06/13/2020

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