Provider Demographics
NPI:1821669516
Name:BELLO BAEZ, MAYDELIN
Entity Type:Individual
Prefix:
First Name:MAYDELIN
Middle Name:
Last Name:BELLO BAEZ
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 1:6951 SW 129TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2470
Mailing Address - Country:US
Mailing Address - Phone:786-543-9346
Mailing Address - Fax:
Practice Address - Street 1:6951 SW 129TH AVE APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2470
Practice Address - Country:US
Practice Address - Phone:786-543-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-143488106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110943400Medicaid