Provider Demographics
NPI:1942833025
Name:BELLA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BELLA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:SERGIO
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:562-716-5620
Mailing Address - Street 1:9916 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6108
Mailing Address - Country:US
Mailing Address - Phone:323-564-1100
Mailing Address - Fax:
Practice Address - Street 1:9916 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6108
Practice Address - Country:US
Practice Address - Phone:323-564-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty