Provider Demographics
NPI:1720743438
Name:BELLIARD TORIBIO, KIRSYS
Entity Type:Individual
Prefix:
First Name:KIRSYS
Middle Name:
Last Name:BELLIARD TORIBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PAYNE AVE APT 804
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3551
Mailing Address - Country:US
Mailing Address - Phone:628-800-4344
Mailing Address - Fax:
Practice Address - Street 1:3200 PAYNE AVE APT 804
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-3551
Practice Address - Country:US
Practice Address - Phone:628-800-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty