Healthcare Provider Details

I. General information

NPI: 1114087145
Provider Name (Legal Business Name): KIM BELLOWS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 VILLA LN SUITE 150
NAPA CA
94558-6405
US

IV. Provider business mailing address

18 PENINSULA CT
NAPA CA
94559-4811
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-9660
  • Fax: 707-252-9610
Mailing address:
  • Phone: 310-704-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: