Provider Demographics
NPI:1639325277
Name:BASS, GURGIANA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:GURGIANA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:GURGIANA
Other - Middle Name:
Other - Last Name:STEVKOVSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6973 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6342
Mailing Address - Country:US
Mailing Address - Phone:858-279-9676
Mailing Address - Fax:858-279-0377
Practice Address - Street 1:7011 LINDA VISTA ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6342
Practice Address - Country:US
Practice Address - Phone:858-810-8700
Practice Address - Fax:858-633-4680
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24750103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist