Provider Demographics
NPI:1346468188
Name:DOCTORS REFFINO PEREYRA AND BASILICO FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:DOCTORS REFFINO PEREYRA AND BASILICO FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:BASILICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-267-6653
Mailing Address - Street 1:7522 CAMPBELL ROAD
Mailing Address - Street 2:SUITE100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1726
Mailing Address - Country:US
Mailing Address - Phone:972-267-6653
Mailing Address - Fax:972-248-3604
Practice Address - Street 1:7522 CAMPBELL ROAD
Practice Address - Street 2:SUITE100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1726
Practice Address - Country:US
Practice Address - Phone:972-267-6653
Practice Address - Fax:972-248-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6534261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092507501Medicaid
TX092507501Medicaid
TXG30449Medicare UPIN