Healthcare Provider Details

I. General information

NPI: 1629357736
Provider Name (Legal Business Name): GARY C BELLMAN M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2011
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23101 SHERMAN PL SUITE 402
WEST HILLS CA
91307-2003
US

IV. Provider business mailing address

22647 VENTURA BLVD SUTIE 177
WOODLAND HILLS CA
91364-1416
US

V. Phone/Fax

Practice location:
  • Phone: 818-912-1899
  • Fax: 818-703-0995
Mailing address:
  • Phone: 818-912-1899
  • Fax: 818-703-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY C BELLMAN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 818-703-9500