MEDICARE: ALEXANDRA V BELOPOLSKAYA M. 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	207L00000X	Anesthesiology Physician	A151874	CA

General Provider Information

NPI Number	:	1730541483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA V BELOPOLSKAYA M. D.

Provider Business Mailing Address
First Line	:	2051 MARENGO ST
Second Line	:	IPT C4E100
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1352
Country	:	US
Telephone Number	:	818-445-2251
Fax Number	:

Provider Business Practice Location Address
First Line	:	23055 SHERMAN WAY UNIT 4631
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91308-7037
Country	:	US
Telephone Number	:	818-888-7815
Fax Number	:	818-715-1722

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	08/10/2020

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