Provider Demographics
NPI:1346768611
Name:LUIS, ANNABELLY
Entity Type:Individual
Prefix:
First Name:ANNABELLY
Middle Name:
Last Name:LUIS
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 1:4834 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6426
Mailing Address - Country:US
Mailing Address - Phone:239-321-1002
Mailing Address - Fax:305-625-6236
Practice Address - Street 1:4834 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6426
Practice Address - Country:US
Practice Address - Phone:239-321-1002
Practice Address - Fax:305-625-6236
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician