Provider Demographics
NPI:1104184522
Name:BELLA SIERRA WOMENS CENTER PLLC
Entity type:Organization
Organization Name:BELLA SIERRA WOMENS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAN OOSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-1914
Mailing Address - Street 1:3410 CANYON DE FLORES
Mailing Address - Street 2:#C
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-5372
Mailing Address - Country:US
Mailing Address - Phone:520-459-1914
Mailing Address - Fax:520-459-7130
Practice Address - Street 1:3410 CANYON DE FLORES STE C
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-5373
Practice Address - Country:US
Practice Address - Phone:520-459-1914
Practice Address - Fax:520-459-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36571207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty