Provider Demographics
NPI:1699968826
Name:BELLAMY, ROGER TORRANCE (PA)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:TORRANCE
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIRCLE
Mailing Address - Street 2:STE. 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-853-7451
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:31720 S. TEMEULA PARKWAY. STE. 203
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18486363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical