Provider Demographics
NPI:1275611493
Name:BELL, DAVID (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1521
Mailing Address - Country:US
Mailing Address - Phone:951-691-5123
Mailing Address - Fax:
Practice Address - Street 1:15980 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9587
Practice Address - Country:US
Practice Address - Phone:760-513-6001
Practice Address - Fax:760-513-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39920174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C399200Medicaid
CAC39920Medicare PIN
CA00C399200Medicaid