Healthcare Provider Details

I. General information

NPI: 1689691370
Provider Name (Legal Business Name): SARICE L BASSIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE BLDG A, SUITE 460
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT. 358
VANCOUVER WA
98683-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD12940
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: