Provider Demographics
NPI:1891340477
Name:BELEW, HETHER MICHELL C (LAC)
Entity type:Individual
Prefix:
First Name:HETHER MICHELL
Middle Name:C
Last Name:BELEW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:HETHER
Other - Middle Name:C
Other - Last Name:BELEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:586 KATY DR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6795
Mailing Address - Country:US
Mailing Address - Phone:909-680-9290
Mailing Address - Fax:
Practice Address - Street 1:805 W LA VETA AVE STE 205
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3929
Practice Address - Country:US
Practice Address - Phone:714-677-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist