Provider Demographics
NPI:1902504038
Name:BELLUSA, SARA MAHMOUD
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MAHMOUD
Last Name:BELLUSA
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 1:11138 HUEBNER OAKS APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1267
Mailing Address - Country:US
Mailing Address - Phone:469-231-3471
Mailing Address - Fax:
Practice Address - Street 1:11138 HUEBNER OAKS APT 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1267
Practice Address - Country:US
Practice Address - Phone:469-231-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program