1194813675 NPI number — DR. VINCENT BELLONZI DC,CCN

Table of content: DR. VINCENT BELLONZI DC,CCN (NPI 1194813675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194813675 NPI number — DR. VINCENT BELLONZI DC,CCN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLONZI
Provider First Name:
VINCENT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC,CCN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194813675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 S LAMAR BLVD
Provider Second Line Business Mailing Address:
240
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-8962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-473-8900
Provider Business Mailing Address Fax Number:
512-472-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S LAMAR BLVD
Provider Second Line Business Practice Location Address:
240
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-8962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-473-8900
Provider Business Practice Location Address Fax Number:
512-472-9898
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1181 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN1001X , with the licence number: 6272 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 742704522 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com