Provider Demographics
NPI:1669506549
Name:TSILYA BASS MD INC.
Entity Type:Organization
Organization Name:TSILYA BASS MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TSILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-762-3116
Mailing Address - Street 1:11631 VICTORY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3572
Mailing Address - Country:US
Mailing Address - Phone:818-762-3116
Mailing Address - Fax:818-985-7923
Practice Address - Street 1:11631 VICTORY BLVD
Practice Address - Street 2:STE 103
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-762-3116
Practice Address - Fax:818-985-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA636302084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636301Medicaid
CAA63630Medicare ID - Type Unspecified
CA00A636301Medicaid