Provider Demographics
NPI:1790213130
Name:BASSETT, ROXANN ROCHELLE
Entity Type:Individual
Prefix:MS
First Name:ROXANN
Middle Name:ROCHELLE
Last Name:BASSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 MACKAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3222
Mailing Address - Country:US
Mailing Address - Phone:909-433-9300
Mailing Address - Fax:909-433-9308
Practice Address - Street 1:431 MACKAY DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3222
Practice Address - Country:US
Practice Address - Phone:909-433-9300
Practice Address - Fax:909-433-9308
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator