Provider Demographics
NPI:1023754728
Name:BELLO FERNANDEZ, EUGENIO (RBT)
Entity type:Individual
Prefix:
First Name:EUGENIO
Middle Name:
Last Name:BELLO FERNANDEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 SW 152ND AVE APT D305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3281
Mailing Address - Country:US
Mailing Address - Phone:786-813-6261
Mailing Address - Fax:
Practice Address - Street 1:8300 NW 53RD ST STE 350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-7712
Practice Address - Country:US
Practice Address - Phone:305-776-0728
Practice Address - Fax:561-828-3124
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-193751106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician