Healthcare Provider Details

I. General information

NPI: 1669506549
Provider Name (Legal Business Name): TSILYA BASS MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11631 VICTORY BLVD STE 103
N HOLLYWOOD CA
91606-3572
US

IV. Provider business mailing address

11631 VICTORY BLVD STE 103
N HOLLYWOOD CA
91606-3572
US

V. Phone/Fax

Practice location:
  • Phone: 818-762-3116
  • Fax: 818-985-7923
Mailing address:
  • Phone: 818-762-3116
  • Fax: 818-985-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA63630
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA63630
License Number StateCA

VIII. Authorized Official

Name: DR. TSILYA BASS
Title or Position: PHISICIAN
Credential: M.D.
Phone: 818-762-3116