Provider Demographics
NPI:1962223859
Name:BASS, NEVAEH ANGELIQUE (AA)
Entity type:Individual
Prefix:MS
First Name:NEVAEH
Middle Name:ANGELIQUE
Last Name:BASS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37199 BOSLEY ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4880
Mailing Address - Country:US
Mailing Address - Phone:760-660-2279
Mailing Address - Fax:
Practice Address - Street 1:82380 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-2608
Practice Address - Country:US
Practice Address - Phone:800-207-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician