Provider Demographics
NPI:1417141292
Name:EL TOM, BASSEM (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:EL TOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:27924 SECO CANYON RD
Practice Address - Street 2:STE 101
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3870
Practice Address - Country:US
Practice Address - Phone:818-365-9531
Practice Address - Fax:906-932-5091
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097763207Q00000X
CAC148824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine