Healthcare Provider Details

I. General information

NPI: 1851386809
Provider Name (Legal Business Name): JENI L BELLO MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JENI A LOWE MPT

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 N PONDEROSA DR STE D106
CAMARILLO CA
93010-2376
US

IV. Provider business mailing address

2061 VANGUARD DR
CAMARILLO CA
93010-2133
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-5447
  • Fax:
Mailing address:
  • Phone: 805-388-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: