MEDICARE: MR. SHERWIN A. BASIL AU.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist	AU22	CA
2	231HA2500X	Assistive Technology Supplier Audiologist	AU22	CA
3	235Z00000X	Speech-Language Pathologist	SP1845	CA
4	237600000X	Audiologist-Hearing Aid Fitter	AU22	CA
5	237700000X	Hearing Instrument Specialist	HA1140	CA
6	231H00000X	Audiologist	AU22	CA

General Provider Information

NPI Number	:	1558366567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHERWIN A. BASIL AU.D

Provider Business Mailing Address
First Line	:	5220 CLARK AVE
Second Line	:	STE 100
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2624
Country	:	US
Telephone Number	:	562-439-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 CLARK AVE
Second Line	:	STE 100
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2624
Country	:	US
Telephone Number	:	562-439-9539
Fax Number	:	562-439-2232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/24/2020

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