Healthcare Provider Details

I. General information

NPI: 1467110890
Provider Name (Legal Business Name): STEPHEN FILS BAZILME PA, SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N ESTRELLA PKWY STE 120
GOODYEAR AZ
85338-9271
US

IV. Provider business mailing address

12758 WOOD HOLLOW DR APT 1721
WOODBRIDGE VA
22192-6545
US

V. Phone/Fax

Practice location:
  • Phone: 561-331-7471
  • Fax:
Mailing address:
  • Phone: 561-331-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number109977
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTPPA485
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number683-P.A.
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8614
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-423
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: