MEDICARE: DR. HALEH G BASSIRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A68704	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A68704	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356309041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALEH G BASSIRI MD

Provider Business Mailing Address
First Line	:	1635 DIVISADERO STREET, SUITE 625, BOX 1821
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:	415-476-4029
Fax Number	:	415-476-4150

Provider Business Practice Location Address
First Line	:	1010 CASS ST STE A1C
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-4515
Country	:	US
Telephone Number	:	831-655-3307
Fax Number	:	834-645-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/13/2015

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