Provider Demographics
NPI:1306209754
Name:BELLAGAMBA, MARIA LORETO
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LORETO
Last Name:BELLAGAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APT 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4243
Mailing Address - Country:US
Mailing Address - Phone:786-239-6164
Mailing Address - Fax:
Practice Address - Street 1:9350 FONTAINEBLEAU BLVD
Practice Address - Street 2:APT 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4243
Practice Address - Country:US
Practice Address - Phone:786-239-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant