Healthcare Provider Details

I. General information

NPI: 1871007252
Provider Name (Legal Business Name): BASSIM ATIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41054 RAWLING CT
INDIO CA
92203-4024
US

IV. Provider business mailing address

41054 RAWLING CT
INDIO CA
92203-4024
US

V. Phone/Fax

Practice location:
  • Phone: 800-755-5980
  • Fax:
Mailing address:
  • Phone: 800-755-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: