Healthcare Provider Details

I. General information

NPI: 1245118314
Provider Name (Legal Business Name): NELSON A. BASILIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 B ST
HAYWARD CA
94541-3102
US

IV. Provider business mailing address

2222 SANDPIPER CT
SAN LEANDRO CA
94579-2753
US

V. Phone/Fax

Practice location:
  • Phone: 510-951-0780
  • Fax:
Mailing address:
  • Phone: 510-604-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00854450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: