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General NPI Number Information
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NPI Number | 1477635365
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Entity Type | Organization
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Legal Business Name | JON BELLEVILLE M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 1600 N ROSE AVE
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City | OXNARD
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State | CA
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Zip | 93030-3722
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Country | US
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Telephone | 805-988-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 11999 SAN VICENTE BLVD STE. 440
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City | LOS ANGELES
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State | CA
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Zip | 90049-5131
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Country | US
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Telephone | 310-440-3131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON P. BELLEVILLE
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Credential | M.D.
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Telephone | 310-440-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G57679
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License Number State | CA
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