Provider Demographics
NPI:1497943484
Name:BELLARD, CATHY MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:BELLARD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WILSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2944
Mailing Address - Country:US
Mailing Address - Phone:760-255-2899
Mailing Address - Fax:
Practice Address - Street 1:311 WILSHIRE PL
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2944
Practice Address - Country:US
Practice Address - Phone:760-380-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN204525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN204525OtherLVN