Healthcare Provider Details

I. General information

NPI: 1619237427
Provider Name (Legal Business Name): OSAGIE BELLO MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W LEGION RD STE 1
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

PO BOX 847411
LOS ANGELES CA
90084-7411
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3737
  • Fax:
Mailing address:
  • Phone: 602-441-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA115182
License Number StateCA

VIII. Authorized Official

Name: DR. OSAGIE BELLO
Title or Position: OWNER
Credential: MD
Phone: 202-271-4198