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General NPI Number Information
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NPI Number | 1104946771
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Entity Type | Organization
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Legal Business Name | BELLAIR MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17250 N 43RD AVE SUITE 4
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City | GLENDALE
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State | AZ
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Zip | 85308-4035
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Country | US
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Telephone | 602-978-4157
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Fax | 602-938-8064
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Provider Business Mailing Address
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Address Line | 17250 N 43RD AVE SUITE 4
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City | GLENDALE
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State | AZ
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Zip | 85308-4035
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Country | US
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Telephone | 602-978-4157
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Fax | 602-938-8064
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Authorized Official
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Title or Position | TRUSTEE
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Name | DR. AMOR C. VILLAREAL
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Credential | M.D.
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Telephone | 602-978-4157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 6919
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License Number State | AZ
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