Healthcare Provider Details

I. General information

NPI: 1700146347
Provider Name (Legal Business Name): MATTHEW GRANT BASKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ESPLANADE
CHICO CA
95926-3310
US

IV. Provider business mailing address

7101 S PADRE ISLAND DR
CORPUS CHRISTI TX
78412-4913
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-5557
  • Fax:
Mailing address:
  • Phone: 361-761-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A22719
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: