Healthcare Provider Details

I. General information

NPI: 1316913833
Provider Name (Legal Business Name): PETER H BELOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 305
LA MESA CA
91942-3048
US

IV. Provider business mailing address

8851 CENTER DR STE 305
LA MESA CA
91942-3048
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-0234
  • Fax: 619-442-4837
Mailing address:
  • Phone: 619-442-0234
  • Fax: 619-442-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number00G355710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG35571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: