Provider Demographics
NPI:1093018509
Name:BASILIO, MARIA BERNADETTE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BERNADETTE
Last Name:BASILIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0949
Mailing Address - Country:US
Mailing Address - Phone:702-285-1512
Mailing Address - Fax:
Practice Address - Street 1:6121 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-0949
Practice Address - Country:US
Practice Address - Phone:702-285-1512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor