Provider Demographics
NPI:1962042986
Name:BELLO CRUZ, DANER
Entity Type:Individual
Prefix:
First Name:DANER
Middle Name:
Last Name:BELLO CRUZ
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 1:650 SE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5638
Mailing Address - Country:US
Mailing Address - Phone:786-716-7721
Mailing Address - Fax:
Practice Address - Street 1:650 SE PARK DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5638
Practice Address - Country:US
Practice Address - Phone:786-716-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-104729106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician