Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 33588 | CA |
NPI | 1063441897 |
---|---|
Provider Name | Ms. Stacye L Basye |
First Address | Redlands, CA 92373-0722 |
Second Address | Redlands, CA 92373-4852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51532491 | BCBS (01) | AL |
Q66711 | (02) |