Provider Demographics
NPI:1659937217
Name:BELCHEZ, EILEEN (LVN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BELCHEZ
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 1:1537 H ST SPC 21
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2606
Mailing Address - Country:US
Mailing Address - Phone:760-803-3119
Mailing Address - Fax:
Practice Address - Street 1:1537 H ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2642
Practice Address - Country:US
Practice Address - Phone:760-803-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172566164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA981148127F04227Medicaid
98148127F04227OtherPERSONAL