Provider Demographics
NPI:1912251349
Name:BELLA, ANN RAISSA CAYAS
Entity type:Individual
Prefix:
First Name:ANN RAISSA
Middle Name:CAYAS
Last Name:BELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19350 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-6900
Mailing Address - Country:US
Mailing Address - Phone:310-951-8382
Mailing Address - Fax:
Practice Address - Street 1:19350 VINCENT DR
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-6900
Practice Address - Country:US
Practice Address - Phone:310-951-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist