Individual
JEAN CLAUDE BASSILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4720 HOEN AVE STE 1, SANTA ROSA, CA 95405-7867
(707) 527-9510
(833) 941-2589
Mailing address
1005 NORTHGATE DR # 121, SAN RAFAEL, CA 94903-2500
(707) 527-9510
(833) 941-2589
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
22784
MS
207RN0300X
Nephrology Physician
22784
MS
207RN0300X
Nephrology Physician
Primary
A145695
CA
207RN0300X
Nephrology Physician
A145965
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09481295
—
MS
Enumeration date
07/07/2008
Last updated
04/20/2022
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