Healthcare Provider Details

I. General information

NPI: 1437517489
Provider Name (Legal Business Name): BELINDA ADDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W 4TH ST STE B
PERRIS CA
92570-2016
US

IV. Provider business mailing address

565 N MOUNT VERNON AVE
SAN BERNARDINO CA
92411-2661
US

V. Phone/Fax

Practice location:
  • Phone: 951-355-0030
  • Fax: 951-420-5005
Mailing address:
  • Phone: 909-884-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003812
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95046461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: