Provider Demographics
NPI:1558366567
Name:BASIL, SHERWIN A (AUD)
Entity Type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:A
Last Name:BASIL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2624
Mailing Address - Country:US
Mailing Address - Phone:562-439-9539
Mailing Address - Fax:
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2624
Practice Address - Country:US
Practice Address - Phone:562-439-9539
Practice Address - Fax:562-439-2232
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU22231HA2400X, 231HA2500X, 237600000X, 231H00000X
CASP1845235Z00000X
CAHA1140237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist