Healthcare Provider Details

I. General information

NPI: 1942388152
Provider Name (Legal Business Name): DAVID BELLOSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD STE 103
RIVERVIEW FL
33578-7421
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8740
  • Fax: 813-605-6060
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME86869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: