Provider Demographics
NPI:1366478414
Name:BELSKI, KRYSTYNA T (MD)
Entity type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:T
Last Name:BELSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W H ST
Mailing Address - Street 2:SUITE # 330
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3588
Mailing Address - Country:US
Mailing Address - Phone:209-848-8133
Mailing Address - Fax:209-845-2134
Practice Address - Street 1:1425 W H ST
Practice Address - Street 2:SUITE # 330
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3588
Practice Address - Country:US
Practice Address - Phone:209-848-8133
Practice Address - Fax:209-845-2134
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A458540Medicaid
CA00A458540Medicaid