Provider Demographics
NPI:1427460591
Name:BELLARD, REGINALD ROMAIN (CMT)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:ROMAIN
Last Name:BELLARD
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:DHAHABU
Other - Middle Name:
Other - Last Name:BELLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:4429 W SLAUSON AVE STE 3/4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2717
Mailing Address - Country:US
Mailing Address - Phone:323-833-8774
Mailing Address - Fax:
Practice Address - Street 1:4429 W SLAUSON AVE STE 3/4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2717
Practice Address - Country:US
Practice Address - Phone:323-833-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CA#11777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker