Basic Information
| Provider Information | |||||||||
| NPI: | 1447405303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSTAK | ||||||||
| FirstName: | BELLA | ||||||||
| MiddleName: | LACHICA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT, DPT, GCS, CEEAA, | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOPLEN | ||||||||
| OtherFirstName: | BELLA | ||||||||
| OtherMiddleName: | LACHICA | ||||||||
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| OtherCredential: | PT, DPT, GCS, CEEAA, | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 809 BROADWAY ST. | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313856835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SALINAS VALLEY MEMORIAL HOSPITAL 450 E ROMIE LANE | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107509006 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT18891 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT27435 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.