Healthcare Provider Details

I. General information

NPI: 1841338944
Provider Name (Legal Business Name): BELTONE OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 MAGNOLIA AVE
RIVERSIDE CA
92506-1884
US

IV. Provider business mailing address

5908 MAGNOLIA AVE
RIVERSIDE CA
92506-1884
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-1237
  • Fax: 951-779-1238
Mailing address:
  • Phone: 951-779-1237
  • Fax: 951-779-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA3537
License Number StateCA

VIII. Authorized Official

Name: MR. KENNETH MICHAEL BECERRIL
Title or Position: PRESIDENT
Credential: ACA
Phone: 951-779-1237