Healthcare Provider Details

I. General information

NPI: 1295113116
Provider Name (Legal Business Name): FREDERICK C BASSAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD STE 2100
SACRAMENTO CA
95816-5266
US

IV. Provider business mailing address

3160 FOLSOM BLVD STE 2100
SACRAMENTO CA
95816-5266
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5846
  • Fax:
Mailing address:
  • Phone: 916-734-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0053409
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number009013
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number009013
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number009013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: