MEDICARE: MEEJUNG BELASCO APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3750-033	WI
2	363L00000X	Nurse Practitioner	21604	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	171400019	OTHER	WI	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144459892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEEJUNG BELASCO APNP

Provider Business Mailing Address
First Line	:	PO BOX 894830
Second Line	:	LOCK BOX 4830
City	:	LOS ANGELES
State	:	CA
Zip	:	90189-4830
Country	:	US
Telephone Number	:	702-853-7451
Fax Number	:	909-557-1924

Provider Business Practice Location Address
First Line	:	4244 RIVERWALK PKWY
Second Line	:	STE. 170
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-8509
Country	:	US
Telephone Number	:	951-736-7432
Fax Number	:	951-736-7751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	06/11/2013

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