Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G57679 | CA |
NPI | 1013069426 |
---|---|
Provider Name | Jon P. Belleville |
First Address | Stockton, CA 95219-2369 |
Second Address | Oxnard, CA 93030-3722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 29/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G576790 | (05) | CA |
050083025 | RAILROAD MEDICARE (01) | CA |