Provider Demographics
NPI:1801838016
Name:BELEN, JACQUELINE SUZANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:BELEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:SUZANNE
Other - Last Name:BELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:19875 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5114
Mailing Address - Country:US
Mailing Address - Phone:623-581-8998
Mailing Address - Fax:623-581-5035
Practice Address - Street 1:19875 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5114
Practice Address - Country:US
Practice Address - Phone:623-581-8998
Practice Address - Fax:623-581-5035
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005080207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801838016Medicare PIN
I44510Medicare UPIN
F37116011Medicare ID - Type Unspecified
MI5631358OtherBLUE CARE NETWORK
I44510Medicare UPIN
1801838016Medicare PIN
MI1656313585OtherBLUE CROSS BLUE SHIELD
M30990010Medicare ID - Type Unspecified
MI479246Medicaid
MI17298OtherMCARE
MI4863100Medicaid