Provider Demographics
NPI:1407868367
Name:BELLO, SERGIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:R
Last Name:BELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1134
Mailing Address - Country:US
Mailing Address - Phone:415-392-1386
Mailing Address - Fax:415-329-1771
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-392-1386
Practice Address - Fax:415-329-1771
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66455207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G664551Medicaid
CA00G66455Medicare ID - Type Unspecified
CA00G664551Medicaid