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General NPI Number Information
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NPI Number | 1629371406
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Entity Type | Organization
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Legal Business Name | ANTHONY G. BASSANELLI, MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 44530 SAN PABLO AVE STE 202
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City | PALM DESERT
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State | CA
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Zip | 92260-3598
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Country | US
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Telephone | 760-341-6026
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Fax | 760-341-6027
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Provider Business Mailing Address
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Address Line | 44530 SAN PABLO AVE STE 202
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City | PALM DESERT
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State | CA
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Zip | 92260-3598
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Country | US
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Telephone | 760-341-6026
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Fax | 760-341-6027
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ANTHONY GERARD BASSANELLI
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Credential | MD
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Telephone | 760-341-6026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | G-55820
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License Number State | CA
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