Healthcare Provider Details

I. General information

NPI: 1255240073
Provider Name (Legal Business Name): REGINA BASS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1705 AZAVEDO CT
FOLSOM CA
95630-7342
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP47392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: