Provider Demographics
NPI:1801386800
Name:BASSALI, MARIAM (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:BASSALI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2417
Mailing Address - Country:US
Mailing Address - Phone:559-685-7100
Mailing Address - Fax:
Practice Address - Street 1:1000 N MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2417
Practice Address - Country:US
Practice Address - Phone:559-685-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine