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General NPI Number Information
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NPI Number | 1093181646
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Entity Type | Organization
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Legal Business Name | BASS MEDICAL GROUP
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 19842 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4002
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Country | US
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Telephone | 510-886-8844
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Fax | 510-886-2936
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Provider Business Mailing Address
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Address Line | 2637 SHADELANDS DR
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RAJIV NAGESETTY
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Credential | MD
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Telephone | 925-948-8154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G061064
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License Number State | CA
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