1225131105 NPI number — VENUGOPAL BELLUM MD

Table of content: VENUGOPAL BELLUM MD (NPI 1225131105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225131105 NPI number — VENUGOPAL BELLUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLUM
Provider First Name:
VENUGOPAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1225131105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10725 INTERNATIONAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-631-3010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10725 INTERNATIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CORDOVA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95670-7967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-631-3010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

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: 207Q00000X , with the licence number:  MD00046361 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29874 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911019392 . This is a "COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 219903 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8456337 . This is a "CHPW" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8456337 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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