MEDICARE: MR. GREGORY EDWARD BASILA R.D.

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	133V00000X	Registered Dietitian	724514

General Provider Information

NPI Number	:	1861586307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY EDWARD BASILA R.D.

Provider Business Mailing Address
First Line	:	2615 E. CLINTON AVENUE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-2286
Country	:	US
Telephone Number	:	559-225-6100
Fax Number	:	559-241-6483

Provider Business Practice Location Address
First Line	:	2615 E. CLINTON AVENUE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-2286
Country	:	US
Telephone Number	:	559-225-6100
Fax Number	:	559-241-6483

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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