Provider Demographics
NPI:1861428435
Name:BELLA VISTA MULTI SPECIALTY MEDICAL GROUP INC
Entity type:Organization
Organization Name:BELLA VISTA MULTI SPECIALTY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DHAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-700-0390
Mailing Address - Street 1:3404 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1539
Mailing Address - Country:US
Mailing Address - Phone:213-700-0390
Mailing Address - Fax:
Practice Address - Street 1:3404 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1539
Practice Address - Country:US
Practice Address - Phone:213-700-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32299207R00000X
CA20A8058207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH81730Medicare UPIN
CAA26754Medicare UPIN