Provider Demographics
NPI:1477233765
Name:BELOTE, BRANDYN M
Entity Type:Individual
Prefix:
First Name:BRANDYN
Middle Name:M
Last Name:BELOTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRANDYN
Other - Middle Name:M
Other - Last Name:WARDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5724 CONTENTA CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5146
Mailing Address - Country:US
Mailing Address - Phone:909-561-6279
Mailing Address - Fax:
Practice Address - Street 1:11175 CAMPUS ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-558-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical