MEDICARE: DR. CORINNE VIVIAN BASCH M.D.

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	207Q00000X	Family Medicine Physician	A51185	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	:	1790853083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORINNE VIVIAN BASCH M.D.

Provider Business Mailing Address
First Line	:	4641 VALLEY EAST BLVD.
Second Line	:	SUITE 2
City	:	ARCATA
State	:	CA
Zip	:	95521
Country	:	US
Telephone Number	:	707-840-4701
Fax Number	:	855-420-6321

Provider Business Practice Location Address
First Line	:	4641 VALLEY EAST BLVD.
Second Line	:	SUITE 2
City	:	ARCATA
State	:	CA
Zip	:	95521
Country	:	US
Telephone Number	:	707-840-4701
Fax Number	:	855-420-6321

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	12/04/2025

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