Healthcare Provider Details

I. General information

NPI: 1962870469
Provider Name (Legal Business Name): BELLAMAY MONTESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE PSC 106B
LOS ANGELES CA
90089-5305
US

IV. Provider business mailing address

1985 ZONAL AVE PSC 106B
LOS ANGELES CA
90089-5305
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-9376
  • Fax:
Mailing address:
  • Phone: 310-592-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number73371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: