Provider Demographics
NPI:1144459892
Name:BELASCO, MEEJUNG (APNP)
Entity type:Individual
Prefix:
First Name:MEEJUNG
Middle Name:
Last Name:BELASCO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BELASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 894830
Mailing Address - Street 2:LOCK BOX 4830
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4830
Mailing Address - Country:US
Mailing Address - Phone:702-853-7451
Mailing Address - Fax:909-557-1924
Practice Address - Street 1:4244 RIVERWALK PKWY
Practice Address - Street 2:STE. 170
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8509
Practice Address - Country:US
Practice Address - Phone:951-736-7432
Practice Address - Fax:951-736-7751
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3750-033363L00000X
CA21604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144459892Medicaid
WI171400019OtherMEDICARE
CAGC137YMedicare PIN
WI1144459892Medicaid