MEDICARE: TSILYA BASS 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	208D00000X	General Practice Physician	A63630	CA
2	2084P0800X	Psychiatry Physician	A63630	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	:	1841330800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSILYA BASS M.D.

Provider Business Mailing Address
First Line	:	1111 N FAIRFAX AVE STE 109
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5363
Country	:	US
Telephone Number	:	323-876-1500
Fax Number	:	323-876-1515

Provider Business Practice Location Address
First Line	:	1111 N FAIRFAX AVE STE 109
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5363
Country	:	US
Telephone Number	:	323-876-1500
Fax Number	:	323-876-1515

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/07/2020

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Directions to “ TSILYA BASS M.D.” Practice Location

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