Healthcare Provider Details

I. General information

NPI: 1346527520
Provider Name (Legal Business Name): LEWIS J BASILE BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 GUILLEMOT AVE
NORTH LAS VEGAS NV
89084-3144
US

IV. Provider business mailing address

10617 TURQUOISE VALLEY DR
LAS VEGAS NV
89144-4109
US

V. Phone/Fax

Practice location:
  • Phone: 702-413-3308
  • Fax:
Mailing address:
  • Phone: 702-413-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: