MEDICARE: BELLA MEDICAL GROUP INC

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	208000000X	Pediatrics Physician	A73468	CA
2	207Q00000X	Family Medicine Physician	A60865	CA

General Provider Information

NPI Number	:	1710261284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2933 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1528
Country	:	US
Telephone Number	:	323-263-2669
Fax Number	:	323-263-2673

Provider Business Practice Location Address
First Line	:	2933 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1528
Country	:	US
Telephone Number	:	323-263-2669
Fax Number	:	323-263-2673

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOSE SERGIO SANDOVAL
Credential	:	PA-C
Telephone Number	:	562-716-5620

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	03/12/2020

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Directions to “BELLA MEDICAL GROUP INC ” Practice Location

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