Healthcare Provider Details

I. General information

NPI: 1164726378
Provider Name (Legal Business Name): OSAGIE BELLO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W LEGION RD
BRAWLEY CA
92227
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA115182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number279503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: