Provider Demographics
NPI:1063035061
Name:ANNABELLA CAFE CORP
Entity Type:Organization
Organization Name:ANNABELLA CAFE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-537-5383
Mailing Address - Street 1:600 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1214
Mailing Address - Country:US
Mailing Address - Phone:786-537-5383
Mailing Address - Fax:
Practice Address - Street 1:600 W 27TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1214
Practice Address - Country:US
Practice Address - Phone:786-537-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67Medicaid