MEDICARE: MR. REGINALD ROMAIN BELLARD C.M.T.

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	172V00000X	Community Health Worker
2	225700000X	Massage Therapist	#11777	CA

General Provider Information

NPI Number	:	1427460591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD ROMAIN BELLARD C.M.T.

Provider Business Mailing Address
First Line	:	4429 W SLAUSON AVE STE 3/4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2717
Country	:	US
Telephone Number	:	323-833-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4429 W SLAUSON AVE STE 3/4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2717
Country	:	US
Telephone Number	:	323-833-8774
Fax Number	:

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

Provider Enumeration Date	:	05/23/2014
Last Update Date	:	01/03/2020

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