Provider Demographics
NPI:1063185692
Name:BELLO-JONES, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:BELLO-JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 E TUDOR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1144
Mailing Address - Country:US
Mailing Address - Phone:907-222-5100
Mailing Address - Fax:
Practice Address - Street 1:2509 EIDE ST STE 6
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2634
Practice Address - Country:US
Practice Address - Phone:907-301-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK144943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist