Healthcare Provider Details

I. General information

NPI: 1588735468
Provider Name (Legal Business Name): GARY C. BELLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22647 VENTURA BLVD 177
WOODLAND HILLS CA
91364-1416
US

IV. Provider business mailing address

23101 SHERMAN PL SUITE 402
WEST HILLS CA
91307-2003
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 TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number189795
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA51907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: