Provider Demographics
NPI:1861073280
Name:BELLARA, JAYESH MAHESH
Entity type:Individual
Prefix:
First Name:JAYESH
Middle Name:MAHESH
Last Name:BELLARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAYESH
Other - Middle Name:M
Other - Last Name:BELLARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1881 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-8308
Mailing Address - Country:US
Mailing Address - Phone:201-780-6509
Mailing Address - Fax:
Practice Address - Street 1:1400 S MERCEY SPRINGS RD STE I
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4928
Practice Address - Country:US
Practice Address - Phone:209-710-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12692225100000X
CAPT-300339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist