Basic Information
| Provider Information | |||||||||
| NPI: | 1497971055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELORO | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | DIMAPASOC | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT, OCS | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DIMAPASOC | ||||||||
| OtherFirstName: | CHERYL | ||||||||
| OtherMiddleName: | LEANN | ||||||||
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| OtherCredential: | PT, DPT, OCS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15405 HYDRANGEA LN | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923360221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099578797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11276 5TH ST | ||||||||
| Address2: | STE 400 & 450 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917300921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094810437 | ||||||||
| FaxNumber: | 9094810837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 06/10/2010 | ||||||||
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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 | PT30012 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT 30012 | 01 | CA | PHYSICAL THERAPY BOARD OF CALIFORNIA | OTHER |