Individual
CARLIN FAE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5616 CAMPANILE WAY, SAN DIEGO, CA 92115-3707
(916) 832-6576
Mailing address
5616 CAMPANILE WAY, SAN DIEGO, CA 92115-3707
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08578758
KAISER
CA
Enumeration date
08/22/2018
Last updated
08/22/2018
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