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General NPI Number Information
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NPI Number | 1750773727
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Entity Type | Organization
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Legal Business Name | PABLO BASSUK M D INC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 1509 WILSON TER
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City | GLENDALE
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State | CA
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Zip | 91206-4007
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Country | US
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Telephone | 323-943-8577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2027
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City | GLENDALE
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State | CA
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Zip | 91209-2027
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Country | US
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Telephone | 747-273-1129
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | DR. PABLO J BASSUK
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Credential | M.D.
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Telephone | 747-273-1129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A99057
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License Number State | CA
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