Basic Information
Provider Information | |||||||||
NPI: | 1518319086 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BELLO GERMINO | ||||||||
FirstName: | DANIELA | ||||||||
MiddleName: | ANDREA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BELLO GERMINO | ||||||||
OtherFirstName: | DANIELA | ||||||||
OtherMiddleName: | ANDREA DEL VALLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 11883 AMETHYST RD STE 203 | ||||||||
Address2: |   | ||||||||
City: | VICTORVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 923929224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7602418000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11883 AMETHYST RD STE 203 | ||||||||
Address2: |   | ||||||||
City: | VICTORVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 923929224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603818075 | ||||||||
FaxNumber: | 7603818043 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2016 | ||||||||
LastUpdateDate: | 04/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A175157 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.