Provider Demographics
NPI:1073297057
Name:BASALIC, SEBASTIAN FLORENTIN (NP)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:FLORENTIN
Last Name:BASALIC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1620
Mailing Address - Country:US
Mailing Address - Phone:925-395-0792
Mailing Address - Fax:
Practice Address - Street 1:1320 EL CAPITAN DR SUITE 120
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526
Practice Address - Country:US
Practice Address - Phone:925-676-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP950248142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery