Healthcare Provider Details

I. General information

NPI: 1083493050
Provider Name (Legal Business Name): MR. RYAN CARTER BASAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ARDEN WAY STE 119
SACRAMENTO CA
95815-4027
US

IV. Provider business mailing address

1610 ARDEN WAY STE 119
SACRAMENTO CA
95815-4027
US

V. Phone/Fax

Practice location:
  • Phone: 916-400-9321
  • Fax:
Mailing address:
  • Phone: 916-400-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: