Provider Demographics
NPI:1194929356
Name:BASS, MARGARITA (MD)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-409-8597
Mailing Address - Fax:323-441-9907
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:IPT 5TH FLOOR, ROOM C5L 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-409-8597
Practice Address - Fax:323-441-9907
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93115207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedHEALTH CENTERS
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW809BMedicare ID - Type UnspecifiedHUDSON