Provider Demographics
NPI:1831136738
Name:ALZAGATITI, BASSAM IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:IBRAHIM
Last Name:ALZAGATITI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 S CENTRAL ST
Mailing Address - Street 2:# B
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4418
Mailing Address - Country:US
Mailing Address - Phone:559-738-1828
Mailing Address - Fax:559-738-1953
Practice Address - Street 1:1860 S CENTRAL ST
Practice Address - Street 2:# B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4418
Practice Address - Country:US
Practice Address - Phone:559-738-1828
Practice Address - Fax:559-738-1953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48436Medicare UPIN
CA00A563660Medicare ID - Type Unspecified