Provider Demographics
NPI:1568718849
Name:BELLINGER, JOHN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BELLINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81135 AVENIDA PAMPLONA
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203
Mailing Address - Country:US
Mailing Address - Phone:760-775-6654
Mailing Address - Fax:
Practice Address - Street 1:81135 AVENIDA PAMPLONA
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203
Practice Address - Country:US
Practice Address - Phone:760-775-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL102940Medicare PIN