Healthcare Provider Details

I. General information

NPI: 1790544567
Provider Name (Legal Business Name): BASS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 ALTOS OAKS DR STE 2
LOS ALTOS CA
94024-5400
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-0444
  • Fax: 408-358-5125
Mailing address:
  • Phone: 925-627-3424
  • 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: PAULA HEWITT
Title or Position: ENROLLMENT COORDINATOR
Credential:
Phone: 925-378-4512