Provider Demographics
NPI:1235686494
Name:DREW BELNAP, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DREW BELNAP, MD, A MEDICAL CORPORATION
Other - Org Name:SOUTH COAST TMS AND KETAMINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BELNAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-331-7735
Mailing Address - Street 1:4405 MANCHESTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4940
Mailing Address - Country:US
Mailing Address - Phone:760-331-7735
Mailing Address - Fax:
Practice Address - Street 1:4405 MANCHESTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4940
Practice Address - Country:US
Practice Address - Phone:760-331-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107743207L00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty