Individual
DR. KEVIN TATE BELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1501 SUPERIOR AVE STE 115, NEWPORT BEACH, CA 92663-3606
(949) 640-7546
(949) 640-7547
Mailing address
1501 SUPERIOR AVE STE 115, NEWPORT BEACH, CA 92663-3606
(949) 640-7546
(949) 640-7547
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20A12076
CA
207N00000X
Dermatology Physician
51343021
WI
207N00000X
Dermatology Physician
DO1741
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001417140
MEDICARE
WI
05
—
1578736724
—
WI
01
—
51343-021
STATE LICENSE
WI
01
—
P00690402
RAILROAD MEDICARE
WI
Enumeration date
04/09/2008
Last updated
03/07/2023
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