Healthcare Provider Details

I. General information

NPI: 1013069426
Provider Name (Legal Business Name): JON P. BELLEVILLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N ROSE AVE
OXNARD CA
93030-3722
US

IV. Provider business mailing address

3116 W MARCH LN SUITE 200
STOCKTON CA
95219-2369
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2818
  • Fax:
Mailing address:
  • Phone: 209-473-6555
  • Fax: 209-473-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG57679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: