Provider Demographics
NPI:1750686598
Name:BASSETT, PAMELA ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ALICIA
Last Name:BASSETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 WILBUR AVENUE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-881-9255
Mailing Address - Fax:818-881-3397
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-881-9255
Practice Address - Fax:818-881-3397
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13242OtherPHYSICIAN ASSISTANT
CA1027182OtherNATIONAL COMMISSION ON CERTIFICATION