Provider Demographics
NPI:1679206130
Name:BASS, KAMEKA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KAMEKA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 RENWICK LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2843
Mailing Address - Country:US
Mailing Address - Phone:510-478-6810
Mailing Address - Fax:
Practice Address - Street 1:2263 RENWICK LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2843
Practice Address - Country:US
Practice Address - Phone:510-478-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804249163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)