Healthcare Provider Details

I. General information

NPI: 1841116738
Provider Name (Legal Business Name): AMIALYA BELLEROSE ELDER MS, CDN, CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 MISSION CENTER CT STE 210
SAN DIEGO CA
92108-1331
US

IV. Provider business mailing address

7860 MISSION CENTER CT STE 210
SAN DIEGO CA
92108-1331
US

V. Phone/Fax

Practice location:
  • Phone: 619-354-8878
  • Fax: 858-341-7968
Mailing address:
  • Phone: 619-354-8878
  • Fax: 858-341-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003163
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: