=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497062574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIE BELLDEGRUN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 04/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 STEIN PLZ SUITE 373 3RD FLOOR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90095-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-206-1434
-----------------------------------------------------
Fax | 310-794-3513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 811 STRADA VECCHIA RD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90077-3023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-206-1434
-----------------------------------------------------
Fax | 310-794-3513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ARIE SHLOMO BELLDEGRUN
-----------------------------------------------------
Credential | M.D.,FACS
-----------------------------------------------------
Telephone | 310-206-1434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A44477
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------