Provider Demographics
NPI:1518960327
Name:BASS, BARBARA N (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:N
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CARVER CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2616
Mailing Address - Country:US
Mailing Address - Phone:760-446-6404
Mailing Address - Fax:760-446-6415
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:STE B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3183
Practice Address - Country:US
Practice Address - Phone:760-446-6404
Practice Address - Fax:760-446-6415
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66037207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G660370OtherPTAN
CA00G660370OtherPTAN
CAZZZ14433ZMedicare PIN
CA770445816OtherFEDERAL TAX ID NUMBER
CA00G660370Medicare PIN