Provider Demographics
NPI:1164639225
Name:BELOCURA, MARIELOU FIRMA (MSN, APRN, BC-FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIELOU
Middle Name:FIRMA
Last Name:BELOCURA
Suffix:
Gender:F
Credentials:MSN, APRN, BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 COURAGE DR # MS 9-100
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6733
Mailing Address - Country:US
Mailing Address - Phone:707-784-2000
Mailing Address - Fax:707-784-1494
Practice Address - Street 1:2201 COURAGE DR # MS 9-100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6733
Practice Address - Country:US
Practice Address - Phone:707-784-2000
Practice Address - Fax:707-784-1494
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568369163W00000X
CA15014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB683ZMedicare PIN