Healthcare Provider Details

I. General information

NPI: 1003103250
Provider Name (Legal Business Name): BELLO LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 SHADOW VIEW DR
EUGENE OR
97408-4610
US

IV. Provider business mailing address

2746 SHADOW VIEW DR
EUGENE OR
97408-4610
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-0551
  • Fax: 541-465-3831
Mailing address:
  • Phone: 541-345-0551
  • Fax: 541-465-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0103534755
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STACEY CONLON
Title or Position: CO-OWNER
Credential:
Phone: 541-345-0551