Provider Demographics
NPI:1801235320
Name:BASS, JOHN LEE (NP, CNS, PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:BASS
Suffix:
Gender:M
Credentials:NP, CNS, PHD
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Other - Credentials:
Mailing Address - Street 1:TRAUMA & EMERGENCY SURGERY - 1010 MURRAY AVE.
Mailing Address - Street 2:SIERRA VISTA REGIONAL MEDICAL CENTER
Mailing Address - City:SAN LUIS OBIPSO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-546-7821
Mailing Address - Fax:
Practice Address - Street 1:1010 MURRAY AVE
Practice Address - Street 2:TRAUMA & EMERGENCY SURGERY, SVRMC
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1806
Practice Address - Country:US
Practice Address - Phone:805-546-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14574363LC0200X
CA2723364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency