Provider Demographics
NPI:1295934644
Name:DEBELLIS, LORENZO GIOVANNI (BSW)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:GIOVANNI
Last Name:DEBELLIS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 JUNIPERO SERRA DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1209
Mailing Address - Country:US
Mailing Address - Phone:626-242-4931
Mailing Address - Fax:
Practice Address - Street 1:1126 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1551
Practice Address - Country:US
Practice Address - Phone:626-967-1667
Practice Address - Fax:626-967-6027
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner