Healthcare Provider Details

I. General information

NPI: 1053467274
Provider Name (Legal Business Name): BELLAFLOR VILLANUEVA TROMPETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18433 ROSCOE BLVD STE 104
NORTHRIDGE CA
91325-4127
US

IV. Provider business mailing address

18433 ROSCOE BLVD STE 104
NORTHRIDGE CA
91325-4127
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9555
  • Fax: 818-993-9558
Mailing address:
  • Phone: 818-993-9555
  • Fax: 818-993-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA26147
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA26147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: