Provider Demographics
NPI:1386907368
Name:OCSON-BELLEZA, ANGELES E (MD)
Entity type:Individual
Prefix:
First Name:ANGELES
Middle Name:E
Last Name:OCSON-BELLEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELES
Other - Middle Name:O
Other - Last Name:BELLEZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:34 PROSPECT CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1509
Mailing Address - Country:US
Mailing Address - Phone:203-389-0731
Mailing Address - Fax:203-389-0731
Practice Address - Street 1:34 PROSPECT CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1509
Practice Address - Country:US
Practice Address - Phone:203-389-0731
Practice Address - Fax:203-389-0731
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT016856Medicaid
CT016856Medicaid