Healthcare Provider Details

I. General information

NPI: 1114198975
Provider Name (Legal Business Name): KARL D. BASSLER, M.D, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA # 520
LAGUNA HILLS CA
92653-3616
US

IV. Provider business mailing address

23961 CALLE DE LA MAGDALENA # 520
LAGUNA HILLS CA
92653-3616
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-3376
  • Fax: 949-609-1971
Mailing address:
  • Phone: 949-855-3376
  • Fax: 949-609-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA64015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA64015
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA64015
License Number StateCA

VIII. Authorized Official

Name: DR. KARL DAVID BASSLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-855-3376