Healthcare Provider Details

I. General information

NPI: 1326409343
Provider Name (Legal Business Name): BASS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 10/18/2023
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 W NOBLE AVE
VISALIA CA
93291
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 559-713-6515
  • Fax: 559-713-6516
Mailing address:
  • Phone: 925-627-3424
  • Fax: 925-627-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: INEZ WONDEH
Title or Position: CEO
Credential:
Phone: 925-378-4512