Healthcare Provider Details

I. General information

NPI: 1497300628
Provider Name (Legal Business Name): BASSO-WILLIAMS 11 BLADE OF CALIFORNIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 03/01/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W LEGION RD
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

PO BOX 840027
LOS ANGELES CA
90084-0027
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BASSO-WILLIAMS
Title or Position: DIRECTOR
Credential: DO
Phone: 209-956-7732