Organization
BASS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INEZ WONDEH (COO)
(925) 378-4512
Entity
Organization
Contact information
Practice address
2350 COUNTRY HILLS DR, SUITE B, ANTIOCH, CA 94509-7436
(925) 528-2663
(925) 757-2160
Mailing address
2637 SHADELANDS DR, WALNUT CREEK, CA 94598-2512
(925) 948-8143
(925) 215-4540
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7360010003
NSC MEDICARE
—
Enumeration date
05/21/2015
Last updated
10/18/2023
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