Healthcare Provider Details

I. General information

NPI: 1669709895
Provider Name (Legal Business Name): BASSEY BASSEY ENUN-ABARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E CARSON PLAZA DR STE 119
CARSON CA
90746-3218
US

IV. Provider business mailing address

PO BOX 723
TORRANCE CA
90508-0723
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-6030
  • Fax: 310-763-1199
Mailing address:
  • Phone: 310-532-6030
  • Fax: 310-763-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-E0910192252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: