Provider Demographics
NPI:1295113116
Name:BASSAL, FREDERICK C (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:C
Last Name:BASSAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5266
Mailing Address - Country:US
Mailing Address - Phone:916-734-5846
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5266
Practice Address - Country:US
Practice Address - Phone:916-734-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0053409208000000X
AZ009013208000000X, 2084N0402X
390200000X
CA0090132084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program