Provider Demographics
NPI:1386167187
Name:BELO, PRESTON (NP-C)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:BELO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SAN RODRIGO
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0505
Mailing Address - Country:US
Mailing Address - Phone:956-424-6119
Mailing Address - Fax:
Practice Address - Street 1:2505 SAN RODRIGO
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0505
Practice Address - Country:US
Practice Address - Phone:956-424-6119
Practice Address - Fax:956-424-6119
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily