Provider Demographics
NPI:1114454113
Name:DARJI, BELLA
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:DARJI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:DARJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:16250 SAND CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3714
Mailing Address - Country:US
Mailing Address - Phone:847-687-6669
Mailing Address - Fax:
Practice Address - Street 1:16250 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-727-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-03-21
Deactivation Date:2022-03-06
Deactivation Code:
Reactivation Date:2022-03-21
Provider Licenses
StateLicense IDTaxonomies
CA95156003163W00000X
IL041418025163W00000X
ILF01171107363LF0000X
IL209015771363L00000X, 363LF0000X
CA95008706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily