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Licensing details for: A 206651

Name: Theodory, Bassam

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: University of California, Riverside School of Medicine

Graduation Year: 2024

Address of Record

8228 Pecan Ave
RANCHO CUCAMONGA CA 91739-9268
SAN BERNARDINO county
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Issuance Date

December 31, 2025

Expiration Date

February 29, 2028

Current Date / Time

April 7, 2026
1:19:57 AM

Public Record Actions

Public Documents

License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: Theodory, Bassam

License/Registration Type: Postgraduate Training License

License Number: 14794 Primary Status: License Canceled

Address :
Riverside Community Hospital
4445 Magnolia Ave
RIVERSIDE CA 92501
RIVERSIDE COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

No AB 133 Survey Information Provided by Licensee

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