Provider Demographics
NPI:1962880195
Name:BELLO, FAUSAT (CCP)
Entity type:Individual
Prefix:
First Name:FAUSAT
Middle Name:
Last Name:BELLO
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-2604
Mailing Address - Country:US
Mailing Address - Phone:310-871-8587
Mailing Address - Fax:
Practice Address - Street 1:570 BARCELONA DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-2604
Practice Address - Country:US
Practice Address - Phone:310-871-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7190192242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist