Basic Information
| Provider Information | |||||||||
| NPI: | 1699708388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLISSIMA | ||||||||
| FirstName: | MARY ANN | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 VALLEY CHILDREN'S PLACE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593533000 | ||||||||
| FaxNumber: | 5593536913 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 VALLEY CHILDREN'S PLACE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593533000 | ||||||||
| FaxNumber: | 5059882387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | DA 1867 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | 3973 | NM | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | AU1867 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.