Basic Information
Provider Information
NPI: 1346566437
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELMONTE
FirstName: JESSICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 933 BRADBURY DR SE
Address2: STE. 2222
City: ALBUQUERQUE
State: NM
PostalCode: 871064374
CountryCode: US
TelephoneNumber: 5052721320
FaxNumber:  
Practice Location
Address1: 1201 CAMINO DE SALUD NE
Address2: UNM CANCER CENTER
City: ALBUQUERQUE
State: NM
PostalCode: 87102
CountryCode: US
TelephoneNumber: 5052724946
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/14/2010
LastUpdateDate: 05/02/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD2017-0208NMN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0003XMD2017-0208NMY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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