Healthcare Provider Details

I. General information

NPI: 1396124574
Provider Name (Legal Business Name): BASS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 COUNTRY HILLS DR SUITE B
ANTIOCH CA
94509-7436
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-528-2663
  • Fax: 925-757-2160
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-215-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: INEZ WONDEH
Title or Position: COO
Credential:
Phone: 925-378-4512