Provider Demographics
NPI:1588666077
Name:BASSO, JOSEPH DOMENIC (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DOMENIC
Last Name:BASSO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TARAVAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1953
Mailing Address - Country:US
Mailing Address - Phone:415-681-2208
Mailing Address - Fax:415-665-0200
Practice Address - Street 1:340 TARAVAL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1953
Practice Address - Country:US
Practice Address - Phone:415-681-2208
Practice Address - Fax:415-665-0200
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1035213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10738Medicare UPIN
CA000E10350Medicare ID - Type Unspecified