Provider Demographics
NPI:1487305074
Name:BELLEZA, ALEXIS MARIE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:BELLEZA
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 1:6651 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8442
Mailing Address - Country:US
Mailing Address - Phone:330-498-9865
Mailing Address - Fax:
Practice Address - Street 1:6651 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8442
Practice Address - Country:US
Practice Address - Phone:330-498-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty