Provider Demographics
NPI:1851936926
Name:BELLA MILAGROS INC
Entity Type:Organization
Organization Name:BELLA MILAGROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-876-5476
Mailing Address - Street 1:14831 SHELBURNE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9503
Mailing Address - Country:US
Mailing Address - Phone:714-876-5476
Mailing Address - Fax:951-272-2988
Practice Address - Street 1:13372 NEWPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3426
Practice Address - Country:US
Practice Address - Phone:714-876-5476
Practice Address - Fax:951-272-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies