1669909339 NPI number — LULIANNA ANNE MEDERIC BELLOT

Table of content: LULIANNA ANNE MEDERIC BELLOT (NPI 1669909339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669909339 NPI number — LULIANNA ANNE MEDERIC BELLOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLOT
Provider First Name:
LULIANNA
Provider Middle Name:
ANNE MEDERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669909339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 NW 175TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33056-4954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-343-8278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8785 SW 165TH AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-206-6500
Provider Business Practice Location Address Fax Number:
786-206-4702
Provider Enumeration Date:
05/12/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)