Provider Demographics
NPI:1861676108
Name:BASSAM SINNO MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BASSAM SINNO MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:SINNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-633-3139
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:B301
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-633-3139
Mailing Address - Fax:760-635-5632
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:B301
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-633-3139
Practice Address - Fax:760-635-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C378310Medicaid
CA00C378310Medicaid