Healthcare Provider Details

I. General information

NPI: 1205820537
Provider Name (Legal Business Name): MELINDA MARIE BELLOMY-MUTH RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE
LONG BEACH CA
90813
US

IV. Provider business mailing address

5509 SUNFIELD AVE
LAKEWOOD CA
90712-1855
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-4844
  • Fax:
Mailing address:
  • Phone: 801-547-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR 163611-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number19904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: