Individual
JOHANNA V BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
520 E FOOTHILL BLVD STE C, POMONA, CA 91767-1200
(909) 398-4835
(909) 398-4925
Mailing address
840 TOWNE CENTER DR, POMONA, CA 91767-5900
(909) 398-1550
(909) 398-1488
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A136671
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/21/2009
Last updated
09/12/2018
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