Provider Demographics
NPI:1821063793
Name:BASA, FRANK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:EDWARD
Last Name:BASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1110 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4505
Mailing Address - Country:US
Mailing Address - Phone:626-357-6769
Mailing Address - Fax:626-357-6743
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:#403
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:626-940-8500
Practice Address - Fax:626-357-6743
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75330173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH79398Medicare UPIN