MEDICARE: BELLAIRE WELLNESS MANAGEMENT INC

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	174400000X	Specialist	J7582	TX

General Provider Information

NPI Number	:	1225286305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLAIRE WELLNESS MANAGEMENT INC

Provider Business Mailing Address
First Line	:	5611 BELLAIRE BLVD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77081-5630
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-339-1518

Provider Business Practice Location Address
First Line	:	5611 BELLAIRE BLVD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77081-5630
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-339-1518

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. RODOLFO MENDEZ- CANCEL
Credential	:	MD
Telephone Number	:	713-339-1566

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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