Provider Demographics
NPI:1699708388
Name:BELLISSIMA, MARY ANN LOUISE (MS)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:LOUISE
Last Name:BELLISSIMA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 VALLEY CHILDREN'S PLACE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636
Mailing Address - Country:US
Mailing Address - Phone:559-353-3000
Mailing Address - Fax:559-353-6913
Practice Address - Street 1:9300 VALLEY CHILDREN'S PLACE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636
Practice Address - Country:US
Practice Address - Phone:559-353-3000
Practice Address - Fax:505-988-2387
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA 1867237600000X
NM3973237600000X
CAAU1867231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter