Provider Demographics
NPI:1215341730
Name:BELMONT, MATTHEW JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:BELMONT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 PACIFIC AVE
Mailing Address - Street 2:APT 11
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5751
Mailing Address - Country:US
Mailing Address - Phone:805-610-9245
Mailing Address - Fax:
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-760-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical