MEDICARE: MR. AIKANE L BELEZ MSED, ATC, CEAS

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	2255A2300X	Athletic Trainer	968	TN

General Provider Information

NPI Number	:	1407818875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AIKANE L BELEZ MSED, ATC, CEAS

Provider Business Mailing Address
First Line	:	3889 FREDONIA DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1211
Country	:	US
Telephone Number	:	312-550-6025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3889 FREDONIA DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1211
Country	:	US
Telephone Number	:	312-550-6025
Fax Number	:

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	01/27/2015

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