Basic Information
| Provider Information | |||||||||
| NPI: | 1689918484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLEZA | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | DELA CRUZ | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 ALA WAI BLVD APT 406 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968153411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082949393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21738 HARDY OAK BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104968050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2012 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | LVN194795 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.