Provider Demographics
NPI:1780195149
Name:BELLOT, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BELLOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 INVERRARY BLVD STE 408I
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4359
Mailing Address - Country:US
Mailing Address - Phone:754-800-2352
Mailing Address - Fax:
Practice Address - Street 1:3800 INVERRARY BLVD STE 408I
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4359
Practice Address - Country:US
Practice Address - Phone:754-800-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021338200Medicaid