Healthcare Provider Details

I. General information

NPI: 1205001112
Provider Name (Legal Business Name): STEVE LA BELLA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 MARENGO AVE
LA MESA CA
91942-2408
US

IV. Provider business mailing address

2557 PIMLICO PL
ALPINE CA
91901-3958
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-6445
  • Fax:
Mailing address:
  • Phone: 619-933-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: