Basic Information
| Provider Information | |||||||||
| NPI: | 1437517489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADDO | ||||||||
| FirstName: | BELINDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 565 N MOUNT VERNON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924112661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098849091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 524 W 4TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925702016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513550030 | ||||||||
| FaxNumber: | 9514205005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95046461 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95003812 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.