Basic Information
| Provider Information | |||||||||
| NPI: | 1215341730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELMONT | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 PACIFIC AVE | ||||||||
| Address2: | APT 11 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902925751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056109245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 SAN MIGUEL DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497608300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1105119 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.