Provider Demographics
NPI:1154636645
Name:BELOUS, VYACHESLAV (DO)
Entity Type:Individual
Prefix:DR
First Name:VYACHESLAV
Middle Name:
Last Name:BELOUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-4000
Mailing Address - Fax:
Practice Address - Street 1:376 VALLOMBROSA AVE
Practice Address - Street 2:STE 99
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3900
Practice Address - Country:US
Practice Address - Phone:530-891-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11870207L00000X
FLUO2562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine