Healthcare Provider Details

I. General information

NPI: 1154401941
Provider Name (Legal Business Name): BASS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6330
  • Fax: 925-932-0139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA78168
License Number StateCA

VIII. Authorized Official

Name: RAJIV NAGESETTY
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 925-932-6330