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General NPI Number Information
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NPI Number | 1447074794
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Entity Type | Individual
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Provider Name | MICHAEL BASOS MSW
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3301 E 12TH ST STE 259
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City | OAKLAND
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State | CA
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Zip | 94601-2940
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Country | US
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Telephone | 510-269-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 1052 VIA ROBLE
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City | LAFAYETTE
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State | CA
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Zip | 94549-2925
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Country | US
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Telephone | 925-588-1706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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