Provider Demographics
NPI:1053994111
Name:BELLENDIR, JACOB JOSEPH
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOSEPH
Last Name:BELLENDIR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH PL STE B119
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2601
Mailing Address - Country:US
Mailing Address - Phone:303-724-7963
Mailing Address - Fax:
Practice Address - Street 1:13001 E 17TH PL STE B119
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2601
Practice Address - Country:US
Practice Address - Phone:303-724-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
COPA.0007465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program