1215938949 NPI number — DR. KARL DAVID BASSLER M.D.

Table of content: DR. KARL DAVID BASSLER M.D. (NPI 1215938949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215938949 NPI number — DR. KARL DAVID BASSLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASSLER
Provider First Name:
KARL
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215938949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23961 MAGDALENA
Provider Second Line Business Mailing Address:
#520
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-855-3376
Provider Business Mailing Address Fax Number:
949-609-1971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23961 MAGDALENA
Provider Second Line Business Practice Location Address:
#520
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-855-3376
Provider Business Practice Location Address Fax Number:
949-609-1971
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A64015 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0900X , with the licence number: A64015 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: A64015 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H17881 . This is a "UPIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DD4828 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00230697 . This is a "RAILROAD MEDICARE PIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A64015 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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