Healthcare Provider Details

I. General information

NPI: 1528267010
Provider Name (Legal Business Name): JEFFREY HOWARD BELABIN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21081 S WESTERN AVE STE 150
TORRANCE CA
90501-1707
US

IV. Provider business mailing address

21081 S WESTERN AVE STE 150
TORRANCE CA
90501-1707
US

V. Phone/Fax

Practice location:
  • Phone: 107-823-3333
  • Fax:
Mailing address:
  • Phone: 107-823-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number9010384
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9101384
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: