Provider Demographics
NPI:1275158891
Name:OSEGUERA, BASILIA BERENICE (MD)
Entity Type:Individual
Prefix:
First Name:BASILIA
Middle Name:BERENICE
Last Name:OSEGUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3139
Mailing Address - Country:US
Mailing Address - Phone:214-294-8989
Mailing Address - Fax:469-399-0355
Practice Address - Street 1:12201 MERIT DR STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3139
Practice Address - Country:US
Practice Address - Phone:214-294-8989
Practice Address - Fax:469-399-0355
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6311207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program