Healthcare Provider Details

I. General information

NPI: 1891406484
Provider Name (Legal Business Name): AZURE BELCARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13343 VANOWEN ST APT 306
VAN NUYS CA
91405-4321
US

IV. Provider business mailing address

13343 VANOWEN ST APT 306
VAN NUYS CA
91405-4321
US

V. Phone/Fax

Practice location:
  • Phone: 213-399-8873
  • Fax:
Mailing address:
  • Phone: 213-399-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number86967
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: