MEDICARE: MARIA BERNADETTE BASILIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1093018509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BERNADETTE BASILIO

Provider Business Mailing Address
First Line	:	6121 PEACH ORCHARD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0949
Country	:	US
Telephone Number	:	702-285-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 PEACH ORCHARD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0949
Country	:	US
Telephone Number	:	702-285-1512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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Directions to “ MARIA BERNADETTE BASILIO ” Practice Location

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