Provider Demographics
NPI:1396023610
Name:BELO, MICHELLE ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNE
Last Name:BELO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:348 HAUSER BLVD
Mailing Address - Street 2:BUILDING 1 APT 418
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3276
Mailing Address - Country:US
Mailing Address - Phone:310-386-3059
Mailing Address - Fax:
Practice Address - Street 1:17980 CASTLETON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1851
Practice Address - Country:US
Practice Address - Phone:626-854-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14207TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist