Provider Demographics
NPI:1790869303
Name:BASA, RANJY CONCHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJY
Middle Name:CONCHA
Last Name:BASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8911 LAKE STEILACOOM POINT RD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5939
Mailing Address - Country:US
Mailing Address - Phone:253-583-1168
Mailing Address - Fax:253-589-4028
Practice Address - Street 1:AMERICAN LAKE VA
Practice Address - Street 2:9600 VETERANS DRIVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1168
Practice Address - Fax:253-589-4028
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228821-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine