Provider Demographics
NPI:1811583461
Name:BASILIO, BERNADETTE (MBA)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:
Last Name:BASILIO
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 KYLE CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166
Mailing Address - Country:US
Mailing Address - Phone:702-321-1677
Mailing Address - Fax:702-395-2850
Practice Address - Street 1:14050 KYLE CANYON ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166
Practice Address - Country:US
Practice Address - Phone:702-321-1677
Practice Address - Fax:702-395-2850
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health