Healthcare Provider Details

I. General information

NPI: 1144459892
Provider Name (Legal Business Name): MEEJUNG BELASCO APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE BELASCO APNP

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 RIVERWALK PKWY STE. 170
RIVERSIDE CA
92505-8509
US

IV. Provider business mailing address

PO BOX 894830 LOCK BOX 4830
LOS ANGELES CA
90189-4830
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-7432
  • Fax: 951-736-7751
Mailing address:
  • Phone: 702-853-7451
  • Fax: 909-557-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3750-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: