Healthcare Provider Details

I. General information

NPI: 1801865688
Provider Name (Legal Business Name): BRYAN LEE BELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVHSOP CAMP PENDLETON BOX 555191
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

32369 CASTLE CT
TEMECULA CA
92592-7109
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1619
  • Fax: 760-725-0051
Mailing address:
  • Phone: 951-303-3910
  • Fax: 760-725-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000872
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: