Basic Information
| Provider Information | |||||||||
| NPI: | 1881605632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 E VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607393144 | ||||||||
| FaxNumber: | 7607392926 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 E VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607393144 | ||||||||
| FaxNumber: | 7607392926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNMW1333 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.