Provider Demographics
NPI:1578377644
Name:BASSEY, SAMSON BASSEY
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:BASSEY
Last Name:BASSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 W 235TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4130
Mailing Address - Country:US
Mailing Address - Phone:310-415-9153
Mailing Address - Fax:
Practice Address - Street 1:2830 W 235TH ST APT 4
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4130
Practice Address - Country:US
Practice Address - Phone:310-415-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024095860163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health