| Doctor Name: | DIANE BASS |
| NPI Number: | 1669687646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | NP12430 |
| Business Practice Address: | 4327 Golden Center Dr Placerville, CA - 956676260 |
| Business Phone Number: | 5306217700 |
| Business Fax Number: | 5306217707 |
| Mailing Address: | 4327 Golden Center Dr, PLACERVILLE |
| State: | CA |
| Postal Code: | 956676260 |
| Phone Number: | 5306420466 |
| Fax Number: | 5306217707 |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | NP12430 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |