Basic Information
| Provider Information | |||||||||
| NPI: | 1417141292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EL TOM | ||||||||
| FirstName: | BASSEM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9602 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913469602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188375559 | ||||||||
| FaxNumber: | 8187924793 | ||||||||
| Practice Location | |||||||||
| Address1: | 27924 SECO CANYON RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913503870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183659531 | ||||||||
| FaxNumber: | 9069325091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301097763 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C148824 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.