MEDICARE: BELLA TEAM LTD.

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	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1548899644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA TEAM LTD.

Provider Business Mailing Address
First Line	:	1940 W ORANGEWOOD AVE STE 205
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 SAN MIGUEL DR STE 1288
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	626-644-0070
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARY MALEK
Credential	:
Telephone Number	:	626-644-0070

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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