Healthcare Provider Details

I. General information

NPI: 1366706012
Provider Name (Legal Business Name): GABRIELLE BASSIN DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 15TH AVE NE
SHORELINE WA
98155-7126
US

IV. Provider business mailing address

14810 15TH AVE NE
SHORELINE WA
98155-7126
US

V. Phone/Fax

Practice location:
  • Phone: 204-206-3366
  • Fax:
Mailing address:
  • Phone: 206-204-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT 60269832
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number18524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: