Healthcare Provider Details

I. General information

NPI: 1568395663
Provider Name (Legal Business Name): SYDNY ROSE BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 17TH ST STE 210
BAKERSFIELD CA
93301-5240
US

IV. Provider business mailing address

1412 17TH ST STE 210
BAKERSFIELD CA
93301-5240
US

V. Phone/Fax

Practice location:
  • Phone: 661-747-2879
  • Fax:
Mailing address:
  • Phone: 661-747-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: