Healthcare Provider Details

I. General information

NPI: 1033929807
Provider Name (Legal Business Name): KRISTEN BELISARIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W 36TH ST
LOS ANGELES CA
90018-3737
US

IV. Provider business mailing address

2325 W 36TH ST
LOS ANGELES CA
90018-3737
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-1785
  • Fax:
Mailing address:
  • Phone: 310-482-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number95150920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: