Provider Demographics
NPI:1891813192
Name:BELIZARIO, EVANGELINA MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINA
Middle Name:MENDOZA
Last Name:BELIZARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:SUITE #321
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-321-1034
Mailing Address - Fax:630-321-1036
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:SUITE #321
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-321-1034
Practice Address - Fax:630-321-1036
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL667920Medicare ID - Type Unspecified
ILC49624Medicare UPIN