Healthcare Provider Details

I. General information

NPI: 1932359056
Provider Name (Legal Business Name): ANTHONY F BELLOMO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 J ST SUITE 210
SACRAMENTO CA
95816-4307
US

IV. Provider business mailing address

2805 J ST SUITE 210
SACRAMENTO CA
95816-4307
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-1973
  • Fax: 916-441-1971
Mailing address:
  • Phone: 916-441-1973
  • Fax: 916-441-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number79283
License Number StateCA

VIII. Authorized Official

Name: ANTHONY F BELLOMO
Title or Position: OWNER
Credential: M.D.
Phone: 916-441-1973