Healthcare Provider Details

I. General information

NPI: 1407750466
Provider Name (Legal Business Name): DOMINIC BASILE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

6133 NE 193RD PL
KENMORE WA
98028-3230
US

V. Phone/Fax

Practice location:
  • Phone: 702-858-6909
  • Fax:
Mailing address:
  • Phone: 702-858-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: