Provider Demographics
NPI:1811518756
Name:GONZALEZ, BASILIA DAWN
Entity type:Individual
Prefix:
First Name:BASILIA
Middle Name:DAWN
Last Name:GONZALEZ
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 1:51 N WEST ST APT D
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1289
Mailing Address - Country:US
Mailing Address - Phone:614-517-6508
Mailing Address - Fax:
Practice Address - Street 1:51 N WEST ST APT D
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1289
Practice Address - Country:US
Practice Address - Phone:614-517-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist