Healthcare Provider Details

I. General information

NPI: 1649487265
Provider Name (Legal Business Name): BELLA AND BRUTUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 MAE ANNE AVE SUITE 1
RENO NV
89523-4726
US

IV. Provider business mailing address

6120 MAE ANNE AVE SUITE 1
RENO NV
89523-4726
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-0196
  • Fax: 855-873-0927
Mailing address:
  • Phone: 775-746-0196
  • Fax: 855-873-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1003100385
License Number StateNV

VIII. Authorized Official

Name: JULIA AI
Title or Position: OWNER
Credential:
Phone: 775-746-0196