Healthcare Provider Details

I. General information

NPI: 1164639225
Provider Name (Legal Business Name): MARIELOU FIRMA BELOCURA MSN, APRN, BC-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/24/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 COURAGE DR # MS 9-100
FAIRFIELD CA
94533-6733
US

IV. Provider business mailing address

2201 COURAGE DR # MS 9-100
FAIRFIELD CA
94533-6733
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2000
  • Fax: 707-784-1494
Mailing address:
  • Phone: 707-784-2000
  • Fax: 707-784-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number568369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: