Healthcare Provider Details

I. General information

NPI: 1407399801
Provider Name (Legal Business Name): KERSTI BELLARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST STE 2720
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

117 BAYSIDE PL
CORONA DEL MAR CA
92625-2856
US

V. Phone/Fax

Practice location:
  • Phone: 504-702-2287
  • Fax: 504-702-2500
Mailing address:
  • Phone: 949-423-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: