Provider Demographics
NPI:1891466975
Name:FREITES BELLO, LUISANA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:LUISANA
Middle Name:ALEJANDRA
Last Name:FREITES BELLO
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 1:2233 SW 147TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4437
Mailing Address - Country:US
Mailing Address - Phone:786-641-1823
Mailing Address - Fax:
Practice Address - Street 1:2233 SW 147TH PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4437
Practice Address - Country:US
Practice Address - Phone:786-641-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-13299106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106631300Medicaid