Individual
ERIC S. BELLFORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546
(209) 342-2300
(209) 524-4240
Mailing address
1000 N HUMPHREYS ST, FLAGSTAFF, AZ 86001-3136
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA14504
CA
364SE0003X
Emergency Clinical Nurse Specialist
PA14504
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPA145040
BLUE SHIELD
CA
05
—
OPA145040
—
CA
Enumeration date
11/03/2005
Last updated
11/18/2020
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