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General NPI Number Information
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NPI Number | 1467110890
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Entity Type | Individual
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Provider Name | STEPHEN FILS BAZILME PA, SA-C
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Gender | Male
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 700 N ESTRELLA PKWY STE 120
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City | GOODYEAR
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State | AZ
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Zip | 85338-9271
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Country | US
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Telephone | 561-331-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 12758 WOOD HOLLOW DR APT 1721
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6545
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Country | US
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Telephone | 561-331-7471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 22-423
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 109977
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TPPA485
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 683-P.A.
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8614
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License Number State | AZ
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