Individual
DR. BLAKE BASSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
NAVAL AIR STATION NORTH ISLAND, 28-64 S R AVE, CORONADO, CA 92118
(619) 545-6210
Mailing address
NAVAL AIR STATION NORTH ISLAND, 28-64 S R AVE, CORONADO, CA 73003
(619) 545-6210
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0102207484
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
N/A
—
Enumeration date
04/04/2021
Last updated
04/14/2023
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